Pharmacological Treatment of Depression in Older Patients with Chronic Obstructive Pulmonary Disease: Impact on the Course of the Disease and Health Outcomes

Abstract

Over 40% older chronic obstructive pulmonary disease (COPD) patients suffer from clinically significant depressive symptoms that may interfere in their daily activities. Untreated depression may increase physical disability, social isolation, hopelessness and healthcare utilization. This review examined the impact of depression on the course of COPD, and the efficacy of antidepressant drugs therapy and their implication for clinical practice. The efficacy of antidepressants from the published trials in patients with COPD has been inconclusive. Specifically, there has been no clear evidence that antidepressants can induce remission of depression or ameliorate dyspnoea or physiological indices of COPD. Both the selective reuptake inhibitors (SSRI) and tricycle antidepressant (TCA) studies conducted in depressed COPD patients have been significantly limited by methodological weaknesses including low sample size, sample heterogeneity, and variability in scales used to diagnose and to monitor the treatment of depression. For this reason, it remains unclear whether which SSRIs or TCAs should be favoured in the treatment of depressed COPD patients and what is an appropriate dosage and duration range. Simply offering antidepressant drugs to older depressed COPD patients is unlikely to improve their conditions. Promising treatment strategies such as cognitive behavioural therapy and collaborative care approach should be considered with or without antidepressants drug therapy for depressed COPD patients. Further studies are needed with large randomised controlled trials to examine the efficacy of antidepressants in patients with COPD with long-term follow-up.

The association of antidepressant treatment with COPD maintenance medication use and adherence in a comorbid Medicare population: A longitudinal cohort study

“…Our findings from administrative data are similar to those of previous studies on antidepressant use in a prevalent and incident cohort of COPD‐depression patients (81% and 70%, respectively) . Our data, however, are higher than those of prior clinical trials and observational studies of COPD patients with comorbid depression . These previous studies were cross sectional with small sample sizes and short follow‐up times, and relied on self‐report for evidence of antidepressant use, reasons that may explain the observed discrepancy.…”

Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…Because both depression and smoking status are potentially modifiable, they may be valuable targets for interventions aimed at reducing COPD readmissions. It is estimated that as many as 40% of patients with COPD have comorbid depression or suffer from depressive symptoms (29,30), and we found a comparable prevalence in our population. However, the percentages in our study and in the general COPD population likely underestimate the actual prevalence of depression, partly because COPD and depression share a number of overlapping symptoms such as decreased energy and fatigue (31), and the effect of COPD …”

Loneliness Mediates the Relationship Between Pain During Intercourse and Depressive Symptoms Among Young Women

“…al., 2011); as such, some of these women may benefit from treatment for depressive symptoms even if these symptoms fall below diagnostic thresholds. Indeed, such treatment has been shown to improve health outcomes, such as quality of life, functional ability, and medication adherence across a range of health populations including people with chronic pain, cancer patients and survivors, and stroke survivors (Ho et al, 2014; Markowitz, Gonzalez, Wilkinson, & Safren, 2011; Osborn, Demoncada, & Feuerstein, 2006; Pence, O’Donnell, & Gaynes, 2012; Yohannes & Alexopoulos, 2014). …”