Depression and COPD Part II: Why Are We Depressed?
In Part I of this series I wrote specifically about how COPD patients have an increased chance of being clinically depressed and how depression affected our illness, and vice versa. Now let's explore the important question: Why are we depressed?
I know what you're thinking. You're thinking “Duh. It's 'cause I'm sick and can't breathe!” And that's true. Yet it's also a bit more complex. So here, in no particular order, are some of the reasons why COPD patients have depression and anxiety.
Aside from not being able to breathe right, fatigue is our biggest complaint and the biggest cause of our depression. According to a study done by Wong, et al, the definition of fatigue is: “the multidimensional sensation of tiredness that the individual experiences when perceiving the reduced capacity to function normally1.” Our quality of life is significantly diminished by fatigue. As COPD patients, we are limited in what we can do and what we can do takes a lot of planning and prioritizing.
We have fear. M. Barnett conducted a study of COPD patients' experiences and outlooks and found we have fear about our decreasing lung function, fear of more exacerbations, fear of becoming more and more dependent on other people, fear of being put into a medical care facility, fear of being bedridden for the rest of our lives, fear of death and dying2. Fear is a major emotional consequence of COPD for many of us and our loved ones.
We have lost our old selves and our old capabilities. We are not going to regain them. As Barnett's patients recounted, we can feel grief, a loss of sense of self, and a vulnerability in our ill health2. We search for a new purpose and new hopes, sometimes not finding them.
4. Dependence on others
Some of us depend on others for help in everyday living. This can lead to feelings of “isolation, lack of support, vulnerability, anxiety, helplessness, powerlessness and/or a certain loss of freedom3 .” Gradually, this role of caregiver and patient between loved ones can become strained, and arguments between the two people can grow, especially when the expectations of either one of them has changed2.
5. Growing social isolation
The worse our COPD is, the further along it is, we tend to become more isolated, simply because of the constant fatigue and shortness of breath. Both are horrible and we don't want to exacerbate either of them with activity. This causes us to feel like we've lost a lot of freedom. We feel like we've lost a lot of spontaneity because outings require so much planning. And if we've lost contact and social interactions with our friends we feel lonely.
Barnett's patients who were smokers felt a lot of guilt and self-blame for their disease. They also felt guilty because smoking and lung diseases carry some societal stigmatization. Non-smokers can also face stigmatization and assumptions because many people in society don't realize non-smokers can also get COPD.
If you have depression for any of these reasons, please know that your feelings are valid. Know that you are not alone. So many of us react the same way when faced with this disease and our reactions are understandable. Please talk to your doctor if you think you are depressed.
Check out Part III of this series for what we can do to deal with depression.
Have you taken our COPD In America Survey yet?