Skip to main content

Advertisement

Log in

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

  • Leading Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. www.goldcopd.org. Date last updated: Feb 2013. Accessed 13 Dec 2013.

  2. Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, Charlson FJ, Norman RE, Flaxman AD, Johns N, Burstein R, Murray CJ, Vos T. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet. 2013;382(9904):1575–86.

    Article  PubMed  Google Scholar 

  3. Yohannes AM, Baldwin RC, Connolly MJ. Mood disorders in patients with chronic obstructive pulmonary disease. Rev Clin Gerontol. 2000;10(2):193–202.

    Article  Google Scholar 

  4. Yohannes AM, Baldwin RC, Connolly MJ. Depression and anxiety in elderly outpatients with disabling pulmonary disease: prevalence and validation of the BASDEC Screening Questionnaire. Int J Geriatr Psychiatry. 2000;15(12):1090–6.

    Article  CAS  PubMed  Google Scholar 

  5. 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 Central  PubMed  Google Scholar 

  6. NICE guideline. Depression in adults: the treatment and management of depression in adults. 2009. www.nice.org.uk/CG090. Accessed 13 Dec 2013.

  7. Yohannes AM, Hann M, Sibbald B. The management of depressive symptoms in patients with COPD: a postal survey of general practitioners. Prim Health Care Res Dev. 2011;12(3):237–44.

    Article  PubMed  Google Scholar 

  8. 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 

  9. 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 

  10. Atlantis E, Fahey P, Cochrane B, Smith S. Bidirectional associations between clinically relevant depression or anxiety and COPD: a systematic review and meta-analysis. Chest. 2013;144(3):766–77.

    Article  PubMed  Google Scholar 

  11. Tsai TY, Livneh H, Lu MC, Tsai PY, Chen PC, Sung FC. Increased risk and related factors of depression among patients with COPD: a population based cohort study. BMC Public Health. 2013;19(13):976. doi:10.1186/1471-2458-13-976.

    Article  Google Scholar 

  12. Yohannes AM, Roomi J, Baldwin RC, Connolly MJ. Depression in elderly outpatients with disabling chronic obstructive pulmonary disease. Age Ageing. 1998;27(2):155–60.

    Article  CAS  PubMed  Google Scholar 

  13. Goodwin RD, Lavoie KL, Lemeshow AR, Jenkins E, Brown ES, Fedoronko DA. Depression, anxiety, and COPD: the unexamined role of nicotine dependence. Nicotine Tob Res. 2012;14(2):176–83.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Yanbaeva DG, Dentener MA, Creutzberg EC, Wesseling G, Wouters EF. Systemic effects of smoking. Chest. 2007;131(5):1557–66.

    Article  CAS  PubMed  Google Scholar 

  15. Nunes SO, Vargas HO, Brum J, Prado E, Vargas MM, de Castro MR, Dodd S, Berk M. A comparison of inflammatory markers in depressed and non-depressed smokers. Nicotine Tob Res. 2012;14(5):540–6.

    Article  CAS  PubMed  Google Scholar 

  16. Lu Y, Feng L, Feng L, Nyunt MS, Yap KB, Ng TP. Systemic inflammation, depression and obstructive pulmonary function: a population-based study. Respir Res. 2013;14:53.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Laurin C, Labrecque M, Dupuis G, Bacon SL, Cartier A, Lavoie KL. Chronic obstructive pulmonary disease patients with psychiatric disorders are at greater risk of exacerbations. Psychosom Med. 2009;71(6):667–74.

    Article  PubMed  Google Scholar 

  18. Ng TP, Niti M, Tan WC, Cao Z, Ong KC, Eng P. Depressive symptoms and chronic obstructive pulmonary disease: effect on mortality, hospital readmission, symptom burden, functional status, and quality of life. Arch Intern Med. 2007;167(1):60–7.

    Article  PubMed  Google Scholar 

  19. Lou P, Chen P, Zhang P, Xu J, Wang Y, Chen N, Zhang L, Wu H, Zhao J. Effects of smoking, depression and anxiety on mortality in COPD patients: a prospective study. Respir Care. 2014;59(1):54–61.

    Article  PubMed  Google Scholar 

  20. Lu Y, Nyunt SZ, Gwee X, Feng L, Feng L, Kua EH, Kumar R, Ng TP. Life event stress and chronic obstructive pulmonary disease (COPD): associations with mental well-being and quality of life in a population-based study. BMJ Open. 2012;2:e001674.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Qian J, Simoni-Wastila L, Langenberg P, Rattinger GB, Zuckerman IH, Lehmann S, Terrin M. Effects of depression diagnosis and antidepressant treatment on mortality in Medicare beneficiaries with chronic obstructive pulmonary disease. J Am Geriatr Soc. 2013;61(5):754–61.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Pirraglia PA, Charbonneau A, Kader B, Berlowitz DR. Adequate initial antidepressant treatment among patients with chronic obstructive pulmonary disease in a cohort of depressed veterans. Prim Care Companion J Clin Psychiatry. 2006;8(2):71–6.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Nelson JC, Delucchi KL, Schneider LS. Moderators of outcome in late life depression: a patient level meta-analysis. Am J Psychiatry. 2013;170(6):651–9.

    Article  PubMed  Google Scholar 

  24. 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 

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

    Article  CAS  PubMed  Google Scholar 

  26. 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 

  27. 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 

  28. 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.

    CAS  PubMed  Google Scholar 

  29. 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 

  30. 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 

  31. 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 

  32. 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 

  33. 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 

  34. Alexopoulos GS, Raue PJ, Sirey JA, Arean PA. Developing an intervention for depressed, chronically medically ill elders: a model from COPD. Int J Geriatr Psychiatry. 2008;23(5):447–53.

    Article  PubMed  Google Scholar 

  35. 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  Google Scholar 

  36. Yohannes AM. Management of anxiety and depression in patients with COPD. Expert Rev Respir Med. 2008;2(3):337–47.

    Article  PubMed  Google Scholar 

  37. Kiosses DN, Klimstra S, Murphy C, Alexopoulos GS. Executive dysfunction and disability in elderly patients with major depression. Am J Geriatr Psychiatry. 2001;9(3):269–74.

    Article  CAS  PubMed  Google Scholar 

  38. Alexopoulos GS, Meyers BS, Young RC, Kakuma T, Feder M, Einhorn A, Rosendahl E. Recovery in geriatric depression. Arch Gen Psychiatry. 1996;53(4):305–12.

    Article  CAS  PubMed  Google Scholar 

  39. Alexopoulos GS, Meyers BS, Young RC, Kalayam B, Kakuma T, Gabrielle M, Sirey JA, Hull J. Executive dysfunction and long-term outcome of geriatric depression. Arch Gen Psychiatry. 2000;57(3):285–90.

    Article  CAS  PubMed  Google Scholar 

  40. Alexopoulos GS, Kiosses DN, Sirey JA, Kanellopoulos D, Novitch RS, Ghosh S, Seirup JK, Raue PJ. Personalised intervention for people with depression and severe COPD. Br J Psychiatry. 2013;202(3):235–6.

    Article  PubMed Central  PubMed  Google Scholar 

  41. First MB, Spitzer L, Robert L, Gibbon M, Williams JBW. Structural clinical interview for DSM-IV-TR axis I. Disorders Research Version, Patient edition (SCID-I/P). Biometrics Research, New York State Psychiatric Institute, 2002.

  42. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23(2):56–62.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  43. Alexopoulos GS, Kiosses DN, Sirey JA, Kanellopoulos D, Seirup JK, Novitch RS, Ghosh S, Banerjee S, Raue PJ. Untangling therapeutic ingredients of a personalized intervention for patients with depression and severe COPD. Am J Geriatr Psychiatry. 2013. doi:10.1016/j.jagp.2013.05.006. [Epub ahead of print].

  44. Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive therapy for depression. New York: Guildford Press; 1979.

    Google Scholar 

  45. Hynninen MJ, Bjerke N, Pallesen S, Bakke PS, Nordhus IH. A randomized controlled trial of cognitive behavioral therapy for anxiety and depression in COPD. Respir Med. 2010;104(7):986–94.

    Article  PubMed  Google Scholar 

  46. Kunik ME, Veazey C, Cully JA, Souchek J, Graham DP, Hopko D, Carter R, Sharafkhaneh A, Goepfert EJ, Wray N, Stanley MA. COPD education and cognitive behavioral therapy group treatment for clinically significant symptoms of depression and anxiety in COPD patients: a randomized controlled trial. Psychol Med. 2008;38(3):385–96.

    Article  CAS  PubMed  Google Scholar 

  47. Alexopoulos GS, Sirey JA, Raue PJ, Kanellopoulos D, Clark TE, Novitch RS. Outcomes of depressed patients undergoing inpatient pulmonary rehabilitation. Am J Geriatr Psychiatry. 2006;14(5):466–75.

    Article  PubMed  Google Scholar 

  48. Shultz E, Malone DA. A practical approach to prescribing antidepressants. Clevl Clin J Med. 2013;80(10):625–31.

    Article  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. M. Yohannes.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-014-0186-0

Keywords

Navigation