Anxiety and Depression Medication in COPD

Depression and anxiety are incredibly common when you have chronic obstructive pulmonary disease (COPD). In fact, medical research shows that about one-quarter of those diagnosed with COPD also show symptoms of depression, and as many as 40% show signs of anxiety.

COPD patients also are 10 times more likely than people without the condition to experience panic attacks and panic disorder — when you can't breathe, it can trigger panic.

It's actually a vicious cycle: When you have depression and/or anxiety, it can lead to more problems with your COPD, including worse quality of life and even a higher risk of death. That's why it's important to treat your anxiety and depression in addition to your COPD.

Unfortunately, several common anti-anxiety medications, such as Xanax and Valium, won't work well in people who also have COPD because they slow down your breathing. But there are several types of medication for depression that might help treat both depression and anxiety.

Here's a guide to several types of anti-depressants that your doctor might consider in conjunction with your COPD treatment, plus a non-drug option to treat your anxiety and depression.


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Selective serotonin reuptake inhibitors (SSRIs) are generally considered the drug treatment of choice for COPD patients who also have depression and/or anxiety.

They are a newer class of antidepressants that work by inhibiting the reuptake of the neurotransmitter serotonin in the brain, subsequently causing a greater amount to be available for the brain to use. Low levels of serotonin have been linked to anxiety and depression.

These brand name anti-depressant drugs are SSRIs:

Studies involving SSRIs in COPD patients haven't shown a conclusive benefit, although they hinted that SSRIs may have fewer side effects than tricyclic anti-depressants.



Tricyclics are the oldest class of antidepressant drugs. They work by blocking the reuptake of two important chemical messengers in your body — serotonin and norepinephrine. These two chemical messengers, known as neurotransmitters, are involved in the regulation of mood.

There are several tricyclics on the market, including:

Although tricyclic antidepressants have been studied in COPD patients, the results of those studies haven't been conclusive. Your doctor is more likely to prescribe an SSRI than a tricyclic anti-depressant, but a tricyclic drug may be best in some cases.



Two of the neurotransmitters in the brain that are responsible for mood regulation, norepinephrine, and serotonin, are in the chemical class monoamines. Monoamine oxidase is an enzyme that breaks down these substances, causing them to be depleted in the brain. Low levels of these neurotransmitters are known to cause depression.

Monoamine oxidase inhibitors (MAOIs), the second oldest class of antidepressants, work by inhibiting the enzyme monoamine oxidase to allow for more norepinephrine and serotonin to remain available in the brain. Brand-name MAOIs include:

  • Marplan
  • Nardil
  • Parnate

Like tricyclic medications, MAOIs aren't considered first-line treatment for depression and anxiety in COPD. However, there may be instances where a MAOI medication is the correct choice.


Newer Antidepressants

A few newer anti-depressants don't fall into any of the above categories:

These medications haven't been well-studied in patients with COPD.

Cognitive Behavioral Therapy

Cognitive behavioral therapy, which is a structured form of psychological therapy offered through counseling with a psychologist or other mental health professional, has shown promise in treating COPD patients.

Although like most anti-depressants, cognitive behavioral therapy hasn't been studied extensively in people with COPD, there's some evidence that COPD patients are more willing to go through cognitive behavioral therapy than they are to take anti-depressant medications, which do have some side effects.


Cantor L et al.

COPD: How to manage comorbid depression and anxiety. Current Psychiatry. November 2003. Vol. 2, No. 11.

Chest. Anxiety and Depression in COPD. CHEST October 2008 vol. 134 no. 4 suppl 43S-56S.

Fritzsche A et al. Effects of medical and psychological treatment of depression in patients with COPD--a review. Respiratory Medicine. 2011 Oct;105(10):1422-33.

Panagioti M et al. Overview of the prevalence, impact, and management of depression and anxiety in chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease. 2014 Nov 13;9:1289-306.

Usmani ZA et al. Pharmacological interventions for the treatment of anxiety disorders in chronic obstructive pulmonary disease. The Cochrane Database of Systematic Reviews. 2011 Nov 9;(11):CD008483.

Yohannes AM et al. Pharmacological treatment of depression in older patients with chronic obstructive pulmonary disease: impact on the course of the disease and health outcomes. Drugs and Aging. 2014 Jul;31(7):483-92.

The Bottom Line

Overall, although there are some good options available for those with COPD and depression and/or anxiety, there's a need for more research to determine the best possible treatment. Your doctor will use your specific medical history to determine what will be most effective for you.

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