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A quick look at the symptoms of COPD explains why so many patients are depressed and anxious. The question is, what can you do to feel better?

Shortness of breath — in order words, no longer being able to take the most basic of things, breathing, for granted. Wheezing. Chest tightness. A chronic cough and a lot of mucus. Involuntary weight loss. Being unable to sleep well. Being scared of a flare-up that may send you to hospital or even threaten your very life.  

Just a cursory look at that list of things people with COPD have to worry about and live with should do a pretty good job of explaining why more than half of people with chronic obstructive pulmonary disease are also diagnosed with depression or anxiety. 

Younger COPD patients are, research shows, at a higher risk of depression and anxiety, maybe because they really weren't expecting to live with a chronic illness at this stage in their life yet, and their COPD symptoms are making it very hard to live their lives the way they want to. 

While it's not difficult to understand why someone with COPD would become anxious, depressed, or (quite often) both, these mental health struggles further chip away at your quality of life and even increase your odds of suffering acute exacerbations. 

What should COPD patients know about anxiety?

A wide variety of individual disorders fall under the general umbrella of "anxiety disorder". This includes Generalized Anxiety Disorder, Panic Disorder, agoraphobia, and obsessive–compulsive disorder. The exact symptoms will vary depending on the disorder in question, of course, but the physical signs of anxiety are pretty much the same across all disorders — an increased heart rate (tachycardia), profuse sweating, and (this is the one you really could do without as a COPD patient) shortness of breath. 

Among COPD patients, anxiety is very often primarily caused by a fear of acute dyspnea — few things are more frightening than not being able to breathe, both because of the physical sensation and its associated fear of dying. The knowledge that COPD is progressive, so your symptoms will get worse, is another common trigger for anxiety. What's more, some COPD meds can make you anxious. 

It's also possible you were already anxious before you were diagnosed with COPD. Research suggests that many people take up smoking — which is also well-known to be a leading cause of chronic obstructive pulmonary disease — to help them cope with anxiety. 

No matter how you become anxious, there are ways to help manage an anxiety disorder:

  • Your doctor may prescribe an anti-anxiety med such as diazepam (Valium) or alprazolam (Xanax), but with caution. That's because these drugs can worsen shortness of breath and also potentially interact with medications you are prescribed to manage your COPD. 
  • Buspirone (BuSpar) is an anxiety medication that shouldn't make your shortness of breath worse and also isn't habit-forming. 
  • Some antidepressants — sertraline (Zoloft), paroxetine (Paxil), or citalopram (Celexa) for instance — can also be prescribed to help manage anxiety disorders. 
  • Because shortness of breath induces anxiety and anxiety induces shortness of breath, pulmonary rehabilitation may also help you with your anxiety. Pulmonary rehabilitation teaches breathing techniques, offers an exercise program, and educates patients about how to live well with COPD. It can ultimately reduce shortness of breath, thereby reducing anxiety. 
  • Talk therapy, such as cognitive behavioral therapy, can play an important role in recovering from anxiety as well. 

What should COPD patients know about depression?

While different studies have reached different conclusions, it's clear that depression is much more prevalent among COPD patients than in the general population. Some studies suggest that a quarter of COPD patients have low-level depression (that doesn't quite meet the diagnostic criteria for major depressive disorder), while others show that COPD patients who are diagnosed with clinical depression have a disproportionate risk that this depression will be moderate or severe. 

Are you depressed? While you'll need a health professional to determine this for sure, the symptoms include:

  • Feeling hopeless, pessimistic, sad, empty, or low, and sometimes agitated and angry
  • Changes in sleep — sleeping a lot, or being unable to sleep well
  • Decreased appetite (depressed people can also have an increased appetite, but eating may be hard for COPD patients in the more advanced stages, so a decreased in appetite is more likely)
  • Being unable to concentrate 
  • Withdrawing from your social circle
  • Loss of interest in everyday activities, or feeling a decreased ability to do these activities
  • In COPD patients specifically — you feel your health has deteriorated, you find it harder to manage flare-ups, and you don't take as much care of your health as you should and could

Should this sound familiar to you, don't resign yourself to feeling like this forever — tell your doctor what you are going through. Depression can be treated, but because you're also taking medications for your COPD, not every antidepressant will be suitable for you. The most common choices are:

  • Sertraline (Zoloft)
  • Citalopram (Celexa).

Be aware that your antidepressant won't "work" right away; most people start feeling better after two weeks to two months. 

As with anxiety, pulmonary rehabilitation and talk therapy, including cognitive behavioral therapy, can also play a very important role in helping a depressed COPD patient feel better. 

  • Laurin, C., Moullec, G., Bacon, S. L., & Lavoie, K. L. (2012). Impact of Anxiety and Depression on Chronic Obstructive Pulmonary Disease Exacerbation Risk. American Journal of Respiratory and Critical Care Medicine, 185(9), 918–923.
  •  Tselebis, A., Pachi, A., Ilias, I., Kosmas, E., Moussas, G., Tzanakis Nikos, N., & Bratis, D. (2016). Strategies to improve anxiety and depression in patients with COPD: a mental health perspective. Neuropsychiatric Disease and Treatment, 297.
  • Photo courtesy of SteadyHealth

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