Anxiety and Depression in COPD

Background

• Anxiety and depression are common in patients with COPD, and should be routinely assessed and adequately treated.
  • Anxiety disorders are characterized by excessive fear and anxiety, and may be accompanied by related behavioral disturbances, such as panic attacks and avoidance.
  • Depressive disorders are characterized by feelings of sadness, emptiness, pessimism, hopelessness, and/or irritability, along with cognitive and somatic symptoms such as lethargy, decreased appetite, reduced sleep, and difficulty concentrating, which have a detrimental effect on the patient’s ability to function.
• Types of depression include early-onset depression defined as depression that develops before the diagnosis of COPD, and late-onset depression or geriatric vascular depression caused by physiologic changes associated with COPD.
• Anxiety in patients with COPD may have been present before the development of COPD.

Evaluation

• Suspect anxiety and/or depression in patients presenting with symptoms such as low mood, loss of interest, or decreased energy.
• Numerous diagnostic instruments may aid in diagnosing and assessing the severity of anxiety and/or depression in patients with COPD.
• Diagnostic criteria vary depending on type of anxiety or depressive disorder.

Management

• No evidence exists that anxiety and/or depression should be treated differently in patients with COPD than in patients without COPD.
• Activity and counseling are the preferred treatments for patients with COPD and mental health difficulties.
• Management varies based on symptom severity and acuity.
• Pharmacologic management is suggested in patients with acute or severe anxiety or depression to avoid long-term effects on overall disability.
• Management should target specific mental health problems and take individual factors into account, including genetic predisposition, nicotine addiction, social support, comorbidities, medication history, warning signs of depression and anxiety, and suicidal ideation.
• Patients with late-onset depression or geriatric vascular depression may be more refractory to treatment with antidepressants.