When COPD Causes Anxiety or Depression

Treatments That Work and Those to Avoid

If you have chronic obstructive pulmonary disease (COPD) or know someone who does, you probably won't be surprised to learn that depression and anxiety are common side effects of this debilitating lung disease. A 2010 study published in the journal Thorax found that people with COPD are more likely to develop anxiety disorders than are those in the general population.

Other studies have reached similar conclusions. In a 2011 study of more than 2,000 adults, 26% of people with COPD suffered from depression compared to 12% of smokers without COPD and 7% of nonsmokers without COPD.

What's more, depression and anxiety in conjunction with COPD can create a vicious cycle. If you have COPD and are struggling to breathe, you can start to panic, making the condition worse. In fact, people with COPD are 10 times more likely than people without the condition to experience panic attacks and panic disorder.

By understanding the causes of COPD-associated depression, you can begin to seek the tools to either prevent or treat the condition.

1

Anti-Anxiety Medications

Depressed Man

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Anti-anxiety medications such as Xanax (alprazolam) and Valium (diazepam) aren't ideal for people with COPD because these drugs tend to slow breathing.

A 2019 study in the Annals of the American Thoracic Society further demonstrated that the use of Xanax or Valium in adults with both COPD and post-traumatic stress disorder (PTSD) more than doubled the risk of suicide.

By contrast, certain antidepressants and psychotherapy may help treat both anxiety and depression and are worth talking to your doctor about.

2

Antidepressants

Prozac, Paxil and Zoloft anti-depressant meds

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There are several classes of antidepressants available for the treatment of depression, some of which are more effective than others. Both of the oldest classes, tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs), have been studied in people with COPD but have not been shown to be helpful.

The same is true of newer antidepressants known as selective serotonin reuptake inhibitors (SSRIs). Even so, SSRIs are considered a better choice for treating depression or anxiety related to COPD.

SSRIs work by preventing the reuptake (reabsorption) of the neurotransmitter serotonin by the nerve cells that secreted it. In this way, more serotonin can be made available in the brain. Low levels of serotonin have been linked to anxiety and depression.

Commonly prescribed SSRIs include:

  • Prozac (fluoxetine)
  • Zoloft (sertraline)
  • Lexapro (escitalopram)
  • Paxil (paroxetine)

Antidepressants that don't fall into any of the abovelisted categories, such as Wellbutrin (bupropion), Serzone (nefazodone), and Remeron (mirtazapine ), haven't been well studied in people with COPD.

3

Cognitive Behavioral Therapy

Psychotherapy for Depression

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If you're like many people with COPD, you may feel more comfortable treating depression or anxiety with cognitive behavioral therapy (CBT) rather than taking a drug. CBT is a structured form of psychological therapy that teaches you to change how you think or feel about situations you can't do anything about.

A 2016 study in the European Respiratory Journal reported that adults with COPD had a 50% greater improvement in depression symptoms after three months of CBT than adults who were given self-help leaflets.

CBT can be a highly effective way of dealing with all sorts of issues related to depression or anxiety caused by COPD, generally works pretty quickly, and doesn't put you at risk of the physical side effects of medication. Your doctor can likely refer you to a psychologist or other mental health professional who can provide you with CBT.

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  1. Eisner MD, Blanc PD, Yelin EH, et al. Influence of anxiety on health outcomes in COPD. Thorax. 2010;65(3):229-34. doi:10.1136/thx.2009.126201

  2. Usmani ZA, Carson KV, Cheng JN, Esterman AJ, Smith BJ. Pharmacological interventions for the treatment of anxiety disorders in chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2011;(11):CD008483. doi:10.1002/14651858.CD008483.pub2

  3. Pascal OI, Trofor AC, Lotrean LM, Filipeanu D, Trofor L. Depression, anxiety and panic disorders in chronic obstructive pulmonary disease patients: correlations with tobacco use, disease severity and quality of life. Tob Induc Dis. 2017;15:23. doi:10.1186/s12971-017-0128-9

  4. Donovan LM, Malte CA, Spece LJ, et al. Risks of benzodiazepines in chronic obstructive pulmonary disease with comorbid posttraumatic stress disorder. Ann Am Thorac Soc. 2019;16(1):82-90. doi:10.1513/AnnalsATS.201802-145OC  

  5. Tselebis A, Pach A, Ilias I, et al. Strategies to improve anxiety and depression in patients with COPD: a mental health perspective. Neuropsychiatr Dis Treat. 2016;2:297-328. doi:10.2147/NDT.S79354

  6. Heslop K, Stenton C, Newton J, et al. A randomised controlled trial of cognitive behavioural therapy (CBT) delivered by respiratory nurses to reduce anxiety in chronic obstructive pulmonary disease (COPD). Eur Respir J. 2016;48:OA289. doi:10.1183/13993003.congress-2016.OA289

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