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

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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. 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 drug therapy and its implications for clinical practice. The efficacy of antidepressants in 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 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. Simply offering antidepressant drugs to older depressed COPD patients is unlikely to improve their condition. Promising treatment strategies such as a collaborative treatment approach and cognitive behavioural therapy should be considered for depressed COPD patients, with or without antidepressant drug therapy. Further studies are needed, including large, randomized, controlled trials with long-term follow-up, to examine the efficacy of antidepressants in patients with COPD.

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Acknowledgements

The project was supported by National Institutes of Health (NIH) grant numbers RO1 MHO 77745, RO1 MHO 76079, RO1 MHO 79414 and P30 MHO 85943. The project was also supported by Manchester Metropolitan University who provided sabbatical leave for Dr. Yohannes.

Conflicts of interest

Dr. Alexopoulos is a stockholder in Johnson and Johnson and has served as a consultant to Lilly and on speakers’ bureaux for Astra Zeneca, Forest, Merck, Avanir and Lundbeck. Dr. Yohannes declares no conflicts of interest relevant to the content of this article.

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  1. Department of Health Professions, Research Institute for Health and Social Care, Manchester Metropolitan University, Manchester, M13 0JA, UK

    A. M. Yohannes

  2. Institute for Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY, USA

    G. S. Alexopoulos

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  1. A. M. Yohannes
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Correspondence to A. M. Yohannes.

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Yohannes, A.M., Alexopoulos, G.S. Pharmacological Treatment of Depression in Older Patients with Chronic Obstructive Pulmonary Disease: Impact on the Course of the Disease and Health Outcomes. Drugs Aging 31, 483–492 (2014). https://doi.org/10.1007/s40266-014-0186-0

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