Pulmonary Disease and Depression

For someone living with chronic obstructive pulmonary disease, the weight on the chest might not be the lungs alone. It could be depression. Roughly 40% of people with COPD also carry a depressive disorder, and a fair number of clinicians think the illness itself helps push patients in that direction. The cruel part is the loop that follows: those depressive symptoms blunt the response to COPD treatment and raise the odds of disability or death.

COPD is, at its core, inflamed airways. Picture chronic bronchitis and emphysema running at the same time, without a break. The inflammation chews up the air sacs and ramps up coughing and mucus. From there the day-to-day problems pile on. Exhaustion, a cough that won't quit, and breathlessness make sleep hard, kill the appetite, drain confidence, and shut people out of the activities they used to enjoy. Hopelessness tends to follow. These are symptoms of the disease, and they double as warning signs of depression.

Does low mood actually slow recovery? A study in the American Journal of Respiratory and Critical Care Medicine took that question seriously. Researchers from China and Canada tracked roughly 500 COPD patients, all age 30 or older, who filed monthly reports on flare-ups and hospital stays. Everyone completed a depression and anxiety inventory at the outset. Twelve months later, the picture was clear enough: patients who had scored high for depression logged more flare-ups and more hospitalizations than those with no sign of it. Higher anxiety scores lined up with flare-ups that dragged on longer.

The team at McGill University in Montreal stopped short of declaring that depression and anxiety make COPD worse, which is the responsible call. Still, the numbers pointed to depression in particular eroding how well the disease could be managed. They offered a few mechanisms. Depression can disturb the immune system, feeding inflammation and leaving a person more exposed to environmental triggers. It can also lower a patient's tolerance for the symptoms themselves, so a flare feels sharper. And it tends to breed indifference toward medical advice, which matters because sticking with treatment is most of what keeps episodes at bay.

That last point anchors a separate study from Andrew Busch, Ph.D., and colleagues at The Centers for Behavioral and Preventive Medicine at The Miriam Hospital. They found that patients carrying both COPD and depression were less likely to finish pulmonary rehabilitation, and the depressive symptoms were the main reason. Pulmonary rehab, or PR, is a drug-free program meant to lift overall quality of life. It builds up a patient's stamina for physical activity, works on deeper breathing, and treats the depression and anxiety alongside everything else. Depression carried a 30% early drop-out rate. Of 111 COPD patients enrolled in the Miriam Hospital program, 68% made it through the full 20 weeks. By the participants' own assessments, a low depression score stood on its own as a factor in finishing.

Walking away from PR worries researchers and physicians for a simple reason: nothing else does as much at once. It is the only program that takes on the lung disease and the mental disorder together. PR gets recommended for people with both conditions because it is relatively safe, it doesn't clash with other medications, it improves a range of COPD symptoms, and it comes with counseling and group therapy. The exercise component may be the most valuable piece. Physical activity helps the lungs, and the evidence says it works on depressive symptoms too. As a whole-person, multi-disciplinary approach, its upsides outweigh its downsides.

Busch wants more research into treating the depression more aggressively. "Depression predicts earlier mortality in those with COPD," he says. "Our results suggest that non completion of pulmonary rehabilitation may be one variable that explains this relationship, and we plan to use these results to help design and implement treatment for depression among those with COPD." Until that work matures, anyone wrestling with both conditions should reach out for help. Depression can't be treated while it goes unnamed. Individual and family therapy, sometimes paired with an antidepressant, may be what keeps the symptoms in check.

What physicians push hardest is movement. Inactivity is the thread that ties COPD and depression together. Physical limits make certain things genuinely hard, but new hobbies and time around other people can lift mood and ease the breathing both. Build a plan, find people to lean on. That is where the healing starts, for the body and the mind alike.

- Melissa Lavery, M.S.

References: Hitti, M. (n.d.). Depression May Worsen COPD. Retrieved January 29, 2015, from webmd.com. Learn COPD Basics. (n.d.). Retrieved January 29, 2015, from copd.com. Lifespan. (2014, July 9). Effect of depressed mood on pulmonary rehab completion. ScienceDaily. Retrieved January 29, 2015. McCoy, K. (2013, March 29). COPD and Depression. Retrieved January 29, 2015, from everydayhealth.com.