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Pharmacological Therapy and Anxiolytics in Patients with Respiratory Diseases

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Depression and Anxiety in Patients with Chronic Respiratory Diseases

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Abstract

Over 40% of older chronic obstructive pulmonary disease (COPD) patients suffer from clinically significant depressive symptoms, which may interfere with their daily activities. This section focuses primarily on antidepressant drug trials that have been conducted in patients with COPD and major depression. It will also examine the benefits of anxiolytics for this patient group. Both selective serotonin reuptake inhibitor (SSRI) and tricyclic antidepressant (TCA) studies conducted in depressed COPD patients have been significantly limited by methodological weaknesses including small sample size, sample heterogeneity and variability in the scales used to diagnose and monitor the treatment of depression. For this reason, it remains unclear which SSRIs or TCAs should be favoured in the treatment of depressed COPD patients and what are appropriate dosages and duration ranges. Lower doses of opioids are beneficial in ameliorating dyspnoea in patients with COPD without series adverse events. However, only a few studies have been conducted to address this question and they are all small in sample size. Additionally, the safety of benzodiazepines for use in patients with severe COPD requires further investigation. Therefore, appropriately powered prospective randomised controlled trials are needed. General guidance and specific medical advice points are provided in how to use antidepressants and anxiolytics in patients with COPD.

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References

  1. World Health Organization report. 2008. http://www.who.int/respiratory/copd/World_Health_Statistics_2008/en/index.html.

  2. Parshall MB, Schwartzstein RM, Adams L, Banzett RB, Manning HL, Bourbeau J, Calverley PM, Gift AG, Harver A, Lareau SC, Mahler DA, Meek PM, O’Donnell DE; on behalf of the ATS Committee on Dyspnea. 2012. An official American thoracic society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med. 2012;185:435–52.

    Google Scholar 

  3. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lives with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis of for the Global burden of disease study 2010. Lancet. 2012;380:2163–96.

    Article  PubMed  Google Scholar 

  4. Sode BF, Dahl M, Nordestgaard BG. Myocardial infarction and other comorbidities with chronic obstructive pulmonary disease: a Danish Nationwide study of 7.4 million individuals. Eur Heart J. 2011;32:2365–75.

    Article  PubMed  Google Scholar 

  5. Elkington H, White P, Addington-Hall J, Higgs R, Edmonds P. The healthcare needs of chronic obstructive pulmonary disease patients in the last years of life. Palliat Med. 2005;19:485–91.

    Article  PubMed  Google Scholar 

  6. Gore JM, Brophy CJ, Greenstone MA. How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer. Thorax. 2000;55(12):1000–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Yohannes AM, Willgoss TG, Baldwin RC, Connolly MJ. Depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease: prevalence, relevance, clinical implications and management principles. Int J Geriatr Psychiatry. 2010;25(12):1209–21.

    Article  CAS  PubMed  Google Scholar 

  8. Hollingworth SA, Siskind DJ. Anxiolytic, hypnotic and sedative medication use in Australia. Pharmacoepidemiol Drug Saf. 2010;19(3):280–8.

    Google Scholar 

  9. Lawrenson RA, Tyrer F, Newson RB, Farmer RD. The treatment of depression in UK general practice: selective serotonin reuptake inhibitors and tricyclic antidepressants compared. J Affect Disord. 2000;59(2):149–57.

    Article  CAS  PubMed  Google Scholar 

  10. Yohannes AM. Palliative care and management principles in older patients with advanced chronic obstructive pulmonary disease. J Ageing Health. 2011;7(3):409–21.

    Article  Google Scholar 

  11. Habraken JM, ter Riet G, Gore JM, Greenstone MA, Weersink EJ, Bindels PJ, Willems DL. Health-related quality of life in end-stage COPD and lung cancer patients. J Pain Symptom Manage. 2009;37(6):973–81.

    Article  PubMed  Google Scholar 

  12. Maurer J, Rebbapragada V, Borson S, Goldstein R, Kunik ME, Yohannes AM, Hanania NA. ACCP workshop panel on anxiety and depression in COPD. Anxiety and depression in COPD: current understanding, unanswered questions, and research needs. Chest. 2008;134(Suppl 4):43S–56S.

    Article  PubMed  PubMed Central  Google Scholar 

  13. NICE guideline. Depression in adults: The treatment and management of depression in adults. 2009. www.nice.org.uk/CG090. Accessed 13 June 2014.

  14. Yohannes AM, Alexopoulos GS. Pharmacological treatment of depression in older patients with chronic obstructive pulmonary disease: impact on the course of the disease and health outcomes. Drugs Aging. 2014;31:483–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Smoller JW, Pollack MH, Systrom D, Kardin RL. Seretraline effects on dyspnoea in patients with obstructive airways. 1998; 39(1):24–9.

    Google Scholar 

  16. Papp LA, Weiss JR, Greenberg HE, Rifkin A, Sharf SM, Gorman JM, et al. Sertraline for chronic obstructive pulmonary disease and comorbid anxiety and mood disorders. Am J Psychiatry. 1995;152(10):1531.

    CAS  PubMed  Google Scholar 

  17. He Y, Zheng Y, Xu C, Yang H, Wang Z, Zhou L, Wan Y, Zheng D, Zhu J. Sertraline hydrocholoride treatment for patients with stable chronic obstructive pulmonary disease complicated with depression: a randomised controlled trial. Clin Respir J. 2016;10:318–25.

    Google Scholar 

  18. Evans M, Hammond M, Wilson K, Lye M, Copeland J. Placebo-controlled treatment trial of depression in elderly physically ill patients. Int J Geriatr Psychiatry. 1997;12(8):817–24.

    Article  CAS  PubMed  Google Scholar 

  19. Yohannes AM, Connolly MJ, Baldwin RC. A feasibility study of antidepressant drug therapy in depressed elderly patients with chronic obstructive pulmonary disease. Int J Geriatr Psychiatry. 2001;16(5):451–4.

    Article  CAS  PubMed  Google Scholar 

  20. Copeland JRM, Kelleher MJ, Kellett JM, Gourlay AJ, Gurland BJ, Fleiss JL, Sharpe L. A semi structured clinical interview for the assessment of diagnosis and mental test in the elderly: the geriatric mental state schedule. 1976;6:439–49.

    CAS  Google Scholar 

  21. Lacasse Y, Beaudoin L, Rousseau L, Maltias F. Randomised trial of paroxetine in end-stage COPD. Monaldi Arch Chest Dis. 2004;61(3):140–7.

    Article  CAS  PubMed  Google Scholar 

  22. Eiser N, Harte R, Karvounis S, Phillips C, Isaac MT. Effect of treating depression on quality of life and exercise tolerance in severe COPD. COPD. 2005;2(2):233–41.

    Article  PubMed  Google Scholar 

  23. Gordon GH, Michiels TM, Mahutte CK, Light RW. Effect of despiramine on control of ventilation and depression scores in patients with chronic obstructive pulmonary disease. Psychiatry Res. 1985;15(1):25–32.

    Article  CAS  PubMed  Google Scholar 

  24. Light RW, Merrill EJ, Despairs J, Gordon GH, Mutalipassi LR. Doxepin treatment of depressed patients with chronic obstructive pulmonary disease. Arch Intern Med. 1986;146(7):1377–80.

    Article  CAS  PubMed  Google Scholar 

  25. Borson S, McDonald GJ, Gayle T, Deffebach M, Lakshminarayan S, van Tunien C. Improvement in mood physical symptoms, and function with nortiptyline for depression in patients with chronic obstructive pulmonary disease. Psychosomatics. 1992;33(2):190–201.

    Article  CAS  PubMed  Google Scholar 

  26. Strom K, Boman G, Pehrsson K, Alton M, Singer J, Rydstrom PO, et al. Effect of protriptyline, 10, mg daily, on chronic hypoxemia in chronic obstructive pulmonary disease. Eur Respir J. 1995;8(3):425–9.

    Article  CAS  PubMed  Google Scholar 

  27. Yohannes AM. General practitioners views and experiences in managing depression in patients with chronic obstructive pulmonary disease. Expert Rev Respir Med. 2012;6(6):589–95.

    Article  CAS  PubMed  Google Scholar 

  28. Sirey JA, Raue PJ, Alexopoulos GS. An intervention to improve depression care in older adults with COPD. Int J Geriatr Psychiatry. 2007;22(3):154–9.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Unützer J, Katon W, Callahan CM, et al. IMPACT investigators. Improving mood-promoting access to collaborative treatment. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA. 2002; 288:2836–45.

    Google Scholar 

  30. Coventry PA, Bower P, Keyworth C, Kenning C, Knopp J, Garrett C, Hind D, Malpass A, Dickens C. The effect of complex interventions on depression and anxiety in chronic obstructive pulmonary disease: systematic review and meta-analysis. PLoS ONE. 2013;8(4):e60532.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Huhn M, Tardy M, Spineli LM, Kissling W, Förstl H, Pitschel-Walz G, Leucht C, Samara M, Dold M, Davis JM, Leucht S. Efficacy of pharmacotherapy and psychotherapy for adult psychiatric disorders: a systematic overview of meta-analyses. JAMA Psychiatry. 2014;71:706–15.

    Article  PubMed  Google Scholar 

  32. Hatcher S, Arroll B. Newer antidepressants for the treatment of depression in adults. BMJ. 2012;344:d8300.

    Article  PubMed  Google Scholar 

  33. National Institute for Health and Clinical Excellence. Chronic obstructive pulmonary disease. www.nice.org.uk/nicemedia/live/13029/49397/49397.pdf. Accessed 5 Aug 2014. Date last updated: June 2010.

  34. Celli BR, MacNee W. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23:932–46.

    Article  CAS  PubMed  Google Scholar 

  35. Vozoris NT, Fischer HD, Wang X, Stephenson AL, Gershon AS, Gruner A, Austin PC, Anderson GM, Bell CM, Gill SS, Rochon PA. Benzodiazepine use among older adults with chronic obstructive pulmonary disease: a population-based cohort study. Drugs Aging. 2013;30:183–92.

    Article  CAS  PubMed  Google Scholar 

  36. Bausewein C, Farquhar M, Booth S, Gysels M, Higginson IJ. Measurement of breathlessness in advanced disease: a systematic review. Resp Med. 2007;101(3):399–410.

    Article  CAS  Google Scholar 

  37. Vestbo J, Hurd SS, Agusti AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187:347–65.

    Article  CAS  PubMed  Google Scholar 

  38. Schwartzstein RM, Lahive K, Pope A, Weinberger SE, Weiss JW. Cold facial simulation reduces breathlessness induced in normal subjects. Am Rev Respir Dis. 1987;136:58–61.

    Article  CAS  PubMed  Google Scholar 

  39. Cranston JM, Crockett A, Moss J, Alpers JM. Domiciliary oxygen for chronic obstructive pulmonary disease. Cochrane Database Sys Rev. 2005;4:CD001744.

    Google Scholar 

  40. Jennings AL, Davies AN, Higgins JP, Gibbs JS, Broadely KE. A systematic review of the use of opioids in the management of dyspnoea. Chest. 2002;57(11):939–44.

    Google Scholar 

  41. O’Donell DE, Aaron S, Bourbeau J, Hermandz P, Marciniuk DD, Balter M, et al. Canadian thoracic society recommendation for management of Chronic obstructive pulmonary disease. Can Respir J. 2007;14(Supp B, 5B–32B).

    Google Scholar 

  42. Mahler DA, Selecky PA, Harrod CG, Benditt JO, Carrieri-Kohlman V, Curtis JR, et al. American college of chest physicians consensus statement on the management of dyspnoea in patients with advanced lung or heart disease. Chest. 2010;137(3):674–91.

    Article  PubMed  Google Scholar 

  43. Ekstrom MP, Bornefalk-Hermansson A, Abernethy AP, Currow DC. Safety of benzodiazepines and opioids in very severe respiratory disease: national prospective study. BMJ. 2014;348:g445.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Vozoris NT, Fischer HD, Wang X, Stephenson AL, Gershon AS, Gruner A, Austin PC, Anderson GM, Bell CM, Gill SS, Rochon PA. Benzodiazepine drug use and adverse respiratory outcomes among older adults with COPD. Eur Respir J. 2014;44:332–40.

    Article  CAS  PubMed  Google Scholar 

  45. Simon ST, Higginson IJ, Booth S, Harding R, Bausewein C. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database Syst Rev. 2010;1: Art No. CD007354. doi:10.1002/14651858. Pub.2.

  46. Stege G, Heijdra YF, van den Elshuout FJJ, van de Ven MJT, de Bruijn PJ, van Sorge AA, Dekhuijen PNR, Vos PJE. Temazepam 10 mg does not affect breathing and gas exchange in patients with severe normoncapnic COPD. Respir Med. 2010;104:518–24.

    Article  PubMed  Google Scholar 

  47. Allcroft P, Margitanovic V, Greene A, Agar MR, Clark K, Abernethy AP, Currow DC. The role of benzodiazepines in breathlessness: a single site, open label pilot of sustained release morphine together with clonazepam. J Palliat Med. 2013;16(7):741–4.

    Article  PubMed  Google Scholar 

  48. Abernethy AP, Currow DC, Frith P, Fazekas BS, McHugh A, Bui C. Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea. BMJ. 2003;327(7414):523–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Currow DC, McDonald C, Oaten S, Kenny B, Allcroft P, Frith P, Briffa M, Johnson MJ, Abernethy AP. Once-daily opioids for chronic dyspnea: a dose increment and pharmacovigilance study. J Pain Symptom Manage. 2011;42(3):388–99.

    Article  CAS  PubMed  Google Scholar 

  50. Young J, Donahue M, Farquhar M, Simpson C, Rocker G. Using opioids to treat dyspnea in advanced COPD: attitudes and experiences of family physicians and respiratory therapists. Can Fam Physician. 2012;58(7):e401–7.

    PubMed  PubMed Central  Google Scholar 

  51. Johnson MJ, Bland JM, Oxberry SG, Abernethy AP, Currow DC. Opioids for chronic refractory breathlessness: patient predictors of beneficial response. Eur Respir J. 2013;42(3):758–66.

    Google Scholar 

  52. Hawkins EJ, Malte CA, Grossbard J, Saxon AJ, Imel ZE, Kivlahan DR. Comparative safety of benzodiazepines and opioids among veterans affairs patients with posttraumatic stress disorder. J Addict Med. 2013;7(5):354–62.

    Google Scholar 

  53. Yohannes AM, Connolly MJ. Do antidepressants work in patients with chronic obstructive pulmonary disease with comorbid depression? Expert Rev Respir Med. 2011;5(6):727–9.

    Article  PubMed  Google Scholar 

  54. Mark TL, Joish VN, Hay JW, Sheehan DV, Johnston SS, Cao Z. Antidepressant use in geriatric populations: the burden of side effects and interactions and their impact on adherence and costs. Am J Geriatric Psychiatry. 2011;19:211–21.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Health Professions, Manchester Metropolitan University, Birley Campus, 53 Bonsall Street, Brooks Building, Manchester, Greater Manchester, M15 6GX, UK

    Abebaw Mengistu Yohannes PhD, MSc

  2. The University of Manchester, Manchester, UK

    Iracema Leroi MD

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  1. Abebaw Mengistu Yohannes PhD, MSc
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  2. Iracema Leroi MD
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Correspondence to Abebaw Mengistu Yohannes PhD, MSc .

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Editors and Affiliations

  1. Professor of Medicine, Department of Medicine, Baylor College of Medicine, Staff Physician, Michael E. DeBakey VA Medical Center, Houston, Texas, USA

    Amir Sharafkhaneh

  2. Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom

    Abebaw Mengistu Yohannes

  3. Baylor College of Medicine, Houston, Texas, USA

    Nicola A. Hanania

  4. Baylor College of Medicine, Houston, Texas, USA

    Mark E. Kunik

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Yohannes, A.M., Leroi, I. (2017). Pharmacological Therapy and Anxiolytics in Patients with Respiratory Diseases. In: Sharafkhaneh, A., Yohannes, A., Hanania, N., Kunik, M. (eds) Depression and Anxiety in Patients with Chronic Respiratory Diseases. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-7009-4_11

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  • DOI: https://doi.org/10.1007/978-1-4939-7009-4_11

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