Bringing awareness to consequences of depression, anxiety in patients with COPD
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Key takeaways:
- Patients with COPD report more depressive symptoms vs. patients without COPD.
- There may be a bidirectional nature in treating depression/anxiety and COPD.
WASHINGTON — Patients with COPD who also have depression and/or anxiety may not be receiving the treatment they need due to their respiratory disease, according to a presentation at the American Thoracic Society International Conference.
“Anxiety and depression are often underrecognized or underappreciated because as clinicians caring for those with COPD, we tend to focus on [patients’] physical symptoms and trying to improve their respiratory symptoms,” Victor Kim, MD, ATSF, FAASM, professor of thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University, told Healio. “Additionally, symptoms of anxiety/depression can often mimic physical symptoms, such as fatigue, breathlessness and difficulty sleeping, making the distinction between anxiety/depression symptoms and symptoms due to respiratory disease a little bit more difficult.”
In order to raise awareness for patients with COPD who are also struggling with a mood disorder, Kim presented data from several studies that demonstrate the prevalence of depression and/or anxiety in this patient population and how the combination of conditions can impact their lives.
According to Kim, the link between COPD and depression/anxiety has been observed in several large cohort studies. In the ECLIPSE study of patients with COPD, smokers with normal lung function (ie, without COPD) and nonsmokers, more patients with COPD had depression symptoms, represented by a Center for Epidemiologic Studies Depression Scale (CES-D) score of 16 or higher, compared with smokers and nonsmokers (26% vs. 12% vs. 7%, respectively).
Notably, patients with more severe COPD experienced more symptoms of depression. In a study of 5,331 patients with either no COPD, PRISm (preserved ratio impaired spirometry), GOLD I-II COPD and GOLD III-IV COPD, those with GOLD III-IV COPD had the greatest frequency of depressive symptoms.
In addition to their mental health, depression in patients with COPD impacts other aspects of their lives, such as quality of life, breathlessness and fatigue, Kim said. Based on ECLIPSE, those with a CES-D score of 16 or higher had poorer 6-minute walk distance, Functional Assessment of Chronic Illness Therapy-Fatigue scores, Medical Research Council Dyspnea scores and St. George’s Respiratory Questionnaire scores compared with patients with COPD without depression (P < .001 for all).
Another study Kim presented found that depression and anxiety have an influence on severe exacerbations.
“Comorbid anxiety and depression can increase risk of severe exacerbations, (ie, requiring an emergency room visit or hospitalization),” Kim said during his presentation. “[The findings show that] mood disorders can increase risk of COPD exacerbations, so that does beg the question of whether mood disorders in COPD are comorbidities, or are these multimorbidities, or separate disorders, that co-exist in the same patient. Do they have a common etiology or not?”
In addition to an increased exacerbation risk, patients with COPD struggling with depression or anxiety also showed higher odds for all-cause readmissions 30 days following their discharge for an exacerbation or respiratory failure (depression aOR = 1.34; 95% CI, 1.29-1.39; anxiety aOR = 1.43; 95% CI, 1.37-1.5), according to another study in Kim’s presentation. Adjusted odds for readmission at 1 year were also elevated in patients with COPD and depression in a separate study, which Kim said demonstrates how the influence of depression is more than temporary.
In terms of treatment, Kim described how depression and anxiety result in poor heart failure outcomes by the way of two proposed mechanisms: biological and behavioral. With this knowledge, Kim said treating the two mood disorders may help with heart failure, and it is possible that the same is true in the opposite direction.
“The existence of anxiety/depression in patients with COPD increases the risk of several poor outcomes,” Kim told Healio. “For that reason, it's important to recognize mood disorders in the overall care of the patient. There is a lot of data now that mental illness and physical illness may be bidirectional. In other words, depression/anxiety does modify someone’s symptoms and vice versa. What needs to be discovered in the future is whether treatment of either will improve the patient’s physical symptoms. For example, starting an antidepressant, medicine or therapy to treat anxiety may reduce their perceptions of breathlessness and therefore health care utilization.”