Risk for incident depression, antidepressant prescriptions elevated in patients with COPD

Patients with confirmed COPD had an increased risk for depression and were more likely to receive a prescription for antidepressant medication than individuals without COPD, according to data published in Respiratory Medicine.

“Mechanisms underlying the association between depression in COPD are not fully understood. Risk factors associated with increased prevalence of depression in COPD are likely multiple and include age, female gender and smoking. The COPD severity has also been associated with an increased prevalence of depression, regardless of how COPD severity is defined,” Rayan A. Siraj, MSc, from the division of respiratory medicine at the University of Nottingham, U.K., and colleagues wrote. “Breathlessness is a core symptom in COPD and has been associated with worse depression symptoms. There may also be a link between COPD and depression through lower socioeconomic class; a risk factor linked to both conditions.”

The large population-based cohort study included 44,362 patients with confirmed COPD (mean age, 67.8 years; 37.5% women) in The Health Improvement Network (THIN) database. Patients were matched with individuals without COPD (n = 124,140; mean age, 67.5 years; 33.7% women) by age, sex and general practitioner.

The incidence rate of depression was higher in patients with COPD compared with individuals without COPD: 11.4 vs. 5.7 per 1,000 person-years after COPD diagnosis (P < .001).

In addition, patients with COPD also had more antidepressant prescriptions compared with individuals without COPD (17.9% vs. 11.7%; P < .001).

Patients with COPD were 42% more likely to have incident depression (adjusted HR = 1.42; 95% CI, 1.32-1.53; P < .001) and 40% more likely to receive a prescription for antidepressant medication (aHR = 1.4; 95% CI, 1.35-1.45; P < .001) compared with individuals without COPD.

The incidence of both depression and antidepressant prescription was also greater among patients with COPD (aHR = 1.41; 95% CI, 1.36-1.46; P < .001).

In the cohort, 2,339 patients with COPD reported worse breathlessness and a Medical Research Council (MRC) dyspnea score of 4 to 5. Compared with the 20,853 patients with less breathlessness and an MRC dyspnea score of 1 to 3, these patients had a higher risk for incident depression (aHR = 1.28; 95% CI, 1.01-1.63; P = .044), antidepressant prescription (aHR = 1.29; 95% CI, 1.16-1.44; P < .001) or either (aHR = 1.32; 95% CI, 1.19-1.46; P < .001).

“Early identification of depression allows health care professionals to develop appropriate treatment strategies, guide the choice of pharmacological and nonpharmacological therapies and minimize the risk of missing critical patients’ symptoms; all of which contribute to better clinical outcomes,” the researchers wrote.