Prevalence, Contribution to Disease Burden and Management of Comorbid Depression and Anxiety in Chronic Obstructive Pulmonary Disease: A Narrative Review

Abstract

Mental health issues such as depression and anxiety are common comorbidities of individuals suffering from chronic obstructive pulmonary disease (COPD), though they are frequently underdiagnosed and consequently undertreated. To that end we sought to identify the impact of co-morbid anxiety and depression in COPD patients and evaluate recent evidence regarding the management of such cases. A Pubmed search was conducted for relevant original articles with emphasis on the past 5 years. The studies we identified indicate that psychiatric comorbidity negatively impacts the prognosis of COPD, as it is associated with reduced adherence to treatment, reduced physical activity and a general reduction in quality of life, in turn leading to more frequent exacerbations and increased severity of exacerbations (which are more likely to require hospitalization), resulting in increased mortality. Despite the evidence showing a high prevalence and exceedingly negative impact of depression and anxiety in patients with COPD, very few clinical trials (for both pharmacological and psychological treatments) with small sample sizes have been conducted in this population. As treatment for co-morbid mental health conditions may reduce mortality, interventions to ensure prompt identification of mental health issues and subsequent initiation of treatment are warranted.

Keywords: Antidepressant; COPD; anxiety; depression; mental health; psychotherapy; quality of life; smoking; smoking cessation.