Abstract
Under-recognised and untreated depression and anxiety symptoms have deleterious effects on physical functioning and social interaction increasing fatigue and healthcare utilisation in patients with chronic obstructive pulmonary disease (COPD). Depression and anxiety are challenging to identify and treat because their symptoms often overlap with those of COPD. The cause(s) of depression and anxiety symptoms are multifactorial and include behavioural, social and biological factors. Less than one-third of COPD patients with comorbid depression or anxiety symptoms are receiving appropriate treatment. Factors that contribute to the lack of provision of treatment are varied, they include patient perceived barriers, for example lack of knowledge and reluctance to receive antidepressant drug therapy; poor treatment compliance and lack of a standardised diagnostic approach; and scarcity of adequate resources for mental health treatment.
The evidence for the efficacy of antidepressant drug therapy in patients with COPD with comorbid depression and anxiety is inconclusive. There are some promising findings regarding pulmonary rehabilitation, psychological therapy and the collaborative care model in reducing depression and anxiety symptoms in patients with COPD, but these findings are limited by short-term follow-up periods. Further work is required to examine the efficacy of these interventions in randomised controlled trials with larger samples and long-term follow-up.
Footnotes
Support statement: This work was supported by grant numbers P30 MH085943 and R01 MH076829 awarded to G.S. Alexopoulos.
Provenance: Submitted article, peer reviewed
Conflict of interest: Disclosures can be found alongside the online version of this article at err.ersjournals.com
- Received October 16, 2013.
- Accepted November 7, 2013.
- ©ERS 2014
ERR articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.