Prevalence and impact of depression in chronic obstructive pulmonary disease patients

PURPOSE OF REVIEW: This review presents recent advances in the study of the depression that is so often co-morbid with chronic obstructive pulmonary disease. The discussion includes prevalence, etiology, impact and management. RECENT FINDINGS: Efforts continue to find a reliable prevalence rate for co-morbid depression in patients with chronic obstructive pulmonary disease but studies regularly find depression in 20-60% of these patients. Multiple etiologies contribute to this elevated rate including genetic predisposition, grief reaction, and effects of chronic obstructive pulmonary disease on the central nervous system. Once depression develops patients are less adherent to treatment plans, lose function and, potentially, suffer worse outcomes in exacerbations. Management of depression in chronic obstructive pulmonary disease continues to be primarily empirical. There are few quality studies demonstrating the usefulness of antidepressants in this population. Some studies suggest selective serotonin reuptake inhibitors will be effective, but require replication in larger groups. Other interventions including psychotherapy, physical rehabilitation, and improved social support are accumulating supporting data, but further research is needed. SUMMARY: Depression is present in up to 60% of patients with chronic obstructive pulmonary disease. It jeopardizes patients' ability to utilize treatment and may increase their risk for poor outcomes. Effective management will require high-quality studies and a multidisciplinary approach.