Abstract
Depression, anxiety, and other mental health disorders, including bipolar disorder and schizophrenia, occur commonly in older adults with chronic obstructive pulmonary disease (COPD), and they are often inadequately treated. We review the available evidence for benefits and risks of pharmacologic treatments (e.g. selective serotonin reuptake inhibitors [SSRIs], serotonin-noradrenaline reuptake inhibitors [SNRIs], tricyclic antidepressants [TCAs], antipsychotic drugs, and benzodiazepines) for common mental illnesses in older persons with COPD. Evidence to use both SSRIs/SNRIs and TCAs from randomized controlled trials is uncertain for treating major depression in patients with COPD. However, population-based findings indicate that they are widely used, and this valuable intervention (preferably SSRIs/SNRIs) should not be denied for selected patients after evaluating potential risks and benefits, especially patients presenting with major depression and suicidal ideation, when a collaborative-care approach is being used. Although there is some evidence for the short-term use of benzodiazepines for treating insomnia, breathlessness, and anxiety in patients with COPD, their long-term use should be closely monitored or avoided to reduce the increased rate of major adverse events. Currently, there are only limited data on the use of antipsychotic drugs for managing schizophrenia or bipolar disorder in older patients with COPD. Hence, clinicians should use extra caution when prescribing antipsychotic agents and be vigilant for symptoms of acute respiratory failure and other adverse effects. Psychotropic medications are clearly beneficial for younger, healthy persons with depression and anxiety; however, the risk–benefit calculation is not so clear for treating psychological problems, schizophrenia, and bipolar disorder in older adults with COPD, given older-adult sensitivity to medications and the mixed findings of relatively few controlled trials.
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This work was partially supported by the use and resources of the Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (CIN13-413) and the South Central Mental Illness Research, Education and Clinical Center. The opinions expressed are those of the authors and not necessarily those of the Department of Veterans Affairs, the US Government, or Baylor College of Medicine.
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AMY contributed to the conceptualization of the review objectives and the development of an outline, completed the literature, and wrote the first draft. JWJ contributed to the conceptualization of the review objectives and the development of an outline, completed the literature, and wrote part of the first draft. MEK contributed to the conceptualization of the review objectives and the development of an outline and edited the first draft before submission. AMY, JWJ and MEK reviewed and edited the whole manuscript and approved the final submission.
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This work was also partially supported by the use and resources of the Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (CIN13-413) and the South Central Mental Illness Research, Education and Clinical Center.
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Abebaw Mengistu Yohannes, Jeff W. Jin, and Mark E. Kunik have no conflicts of interest to declare in relation to this manuscript.
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Yohannes, A.M., Jin, J.W. & Kunik, M.E. Benefit–Risk Assessment of Psychotropic Drugs in Older Patients with Chronic Obstructive Pulmonary Disease. Drugs Aging 39, 323–332 (2022). https://doi.org/10.1007/s40266-022-00935-0
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DOI: https://doi.org/10.1007/s40266-022-00935-0