Effects of medical and psychological treatment of depression in patients with COPD – A review

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory lung disease characterized by progressive and only partially reversible symptoms and by considerable negative consequences such as reductions in functional status and quality of life. Comorbid depression is highly prevalent in patients with COPD and related to a worse course of the disease. Despite its negative impact, depression often remains unrecognized and untreated in COPD patients. This review summarizes the current state of findings from studies examining the effects of antidepressant treatments in patients with COPD. Reviewed treatment options are antidepressant medical therapy and cognitive-behavioral therapy (CBT). Antidepressant medical trials include treatments with selective serotonin reuptake inhibitors (SSRI) or tricyclic antidepressants (TCA); CBT was applied using various components. Across both treatment types, the majority of studies included patients with a wide range of psychiatric conditions and especially comorbid symptoms of anxiety were often not controlled. Furthermore, greatly varying instruments and methods for assessing depressive symptoms, small sample sizes and rather heterogeneous results were observed. This makes the comparison of treatment options rather difficult and prevents definite conclusions. However, some important implications valuable for further research were obtained. Some limited data suggested that SSRI might show fewer side effects than TCA. A few antidepressants as well as beneficial effects in other outcomes were observed after antidepressant medical treatment. More clearly, CBT showed some potential in terms of improvements in depressive symptoms, and also in other outcome measures. Patient compliance seems more promising for CBT than for antidepressant medical treatment. Overall, the reviewed studies suggest some promising effects for both treatment types and effect sizes in studies with significant antidepressant effects were reasonable. However, future randomized controlled trials comparing antidepressant medical and cognitive-behavioral therapy will be essential to assess distinct and most favorable treatment effects. Because recent data is often limited, sound diagnostic criteria of depression and adequate sample sizes are necessary to draw firm conclusions on the effects of these antidepressant treatment options in patients with COPD and comorbid depression.

Depression and suicidality in COPD: understandable reaction or independent disorders?

“…One study [54] reported a large effect size for nortriptyline (Cohen's d -1.07) compared with placebo [10]; however, as only 30 patients completed the study it was strongly underpowered. Due to even more serious methodological limitations of the remaining studies no firm conclusions can be drawn concerning TCAs in patients with comorbid depression and COPD.…”

“…Due to even more serious methodological limitations of the remaining studies no firm conclusions can be drawn concerning TCAs in patients with comorbid depression and COPD. In addition, the acceptability of TCAs in this patient group is clearly limited by their side-effects (especially anticholinergic and antihistaminergic side-effects such as sedation) [10].…”

“…In addition, the drop-out rates in these trials were high (21-50%), and a variety of depression rating scales was used (table 4) [10], Frustration with multiple medications and the fear of side-effects have been discussed as the reasons for high dropout rates for depressed COPD patients reported in these antidepressant trials [10]. Negative effects of SSRIs on lung function in depressed patients with COPD do not appear to be a major problem.…”

“…The efficacy of cognitive and behavioural interventions for depression in patients with COPD (especially cognitive behavioural therapy (CBT)) was well summarised in a recent review [10]. Six RCTs were available.…”

“…However, evidence for the efficacy of antidepressant treatments would be stronger when specifically shown in patients with comorbid depression and COPD. Therefore, the aims of this review are to: 1) review and critically discuss whether the risk of major depression is increased in patients with COPD; 2) review the risk of suicidal behaviour in patients with COPD; 3) give a critical overview of the evidence for efficacy of pharmaco-and psychotherapy in depressed patients with COPD, based on available reviews and more recent studies [7][8][9][10][11]; and 4) provide practical recommendations concerning the diagnosis of and treatment for depression in patients with COPD.…”