Depression and COPD Part I
I know there are a ton of articles about COPD and depression. There are articles about what to do when you're depressed. There are articles about how depression affects the brain. There are articles about how to beat depression, and articles which doubt the terrible burdens of it.
This isn't about any of those
I want to talk specifically about COPD and depression. In Part I of this series, we'll look at how depression affects our illness and how our illness affects our depression.
Are we, as a community, really affected much by depression?
Yes! A recent study conducted by Connolly, et al, stated that the number of COPD patients with depression could be up to 81%.1
Another study by Dahlen and Janson, found that 52% of ER patients who had COPD and depression or anxiety were admitted to the hospital versus 19% of COPD patients without it2. They concluded that patients with more severe COPD (and thus needing to be admitted more frequently) had a higher occurrence of depression, or, alternatively, that having depression and anxiety made their COPD worse. The same study found that ER patients who needed to be admitted again the future had had higher scores on the Hospital Anxiety and Depression scale than patients who didn't need to be seen again2.
So what exactly is depression in this context?
It's more than feeling sad. It's more than having the blues. You can't just “snap out of it.” In his article “Overview of the prevalence, impact, and management of depression and anxiety in chronic obstructive pulmonary disease,” in the International Journal of Chronic Obstructive Pulmonary Disease3, Panagioti defined clinical depression as:
“The two main symptoms of major depression include depressed mood and loss of interest or pleasure in daily activities. Additional symptoms of depression include fatigue or loss of energy, significant changes in weight, appetite, and sleep, guilt/worthlessness, lack of concentration, pessimism about the future, and suicidality. According to the Fifth Edition of the Statistical Manual of Mental Disorders, a diagnosis of major depression is assigned if at least one of two main symptoms and five symptoms in total are present for at least 2 weeks and cause clinically significant impairment in social, occupational, or other important areas of functioning4.”
How do doctors diagnose depression in COPD patients?
Not surprisingly, depression and anxiety in our community do go undiagnosed. Why? Well, they are comorbidities that overlap with COPD. Being tired, not being able to sleep, not having any energy, losing or gaining weight, heart palpitations, brain fog, etc., are symptoms that are the same in both diseases.4 There are tools doctors can use to determine and measure depression in a patient. These usually consist of questionnaires asking the patient to rate their responses to ideas such as hopelessness, joy, self-harm and such.
What are the effects of depression on COPD patients?
As noted above, a higher population of COPD patients with depression are admitted to the hospital2. In a related note, patients admitted to the hospital who also had depression usually stayed twice the amount of time their counterparts without depression did2.
Our quality of life suffers too. It messes with our sleep patterns, whether not being able to fall asleep or stay asleep. We're less likely to take our medications as directed and we are less likely to stop smoking.5 Yohannes also found that instead of our FEV1, which indicates our lung function, depression affected how much energy we had to do everyday activities5.
This is a lot of data to think about. Depression's complexities, affects, and inter-relatedness with COPD are many. If you have any of the symptoms mentioned above, talk to your doctor about being screened for depression.