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Review
. 2025 Sep 18;13(18):2344.
doi: 10.3390/healthcare13182344.

Depression and Anxiety as Comorbidities in Chronic Obstructive Pulmonary Disease: A Comprehensive Narrative Review

Iulian-Laurențiu Buican  1   2 , Alina-Cătălina Buican-Chirea  1   3 , Mădălina Iuliana Mușat  3 , Costin Teodor Streba  2   4
Affiliations
Review

Depression and Anxiety as Comorbidities in Chronic Obstructive Pulmonary Disease: A Comprehensive Narrative Review

Iulian-Laurențiu Buican et al. Healthcare (Basel). .

Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) is a prevalent, progressive condition often associated with psychiatric comorbidities such as depression and anxiety, which negatively affect disease progression, treatment adherence, and quality of life. Methods: A narrative review was conducted by searching PubMed and Google Scholar for English-language publications from January 2015 to July 2025. This type of review was selected to allow for a broad and integrative analysis of the current evidence on the association between COPD and psychiatric comorbidities, particularly depression and anxiety. To increase comprehensiveness, the reference lists of the included articles and systematic reviews were manually screened, and data extraction and evaluation were conducted independently by two reviewers. Results: Reported prevalence rates vary widely in COPD patients with depression ranging from 10 to 57% and anxiety from 7 to 50%, largely due to differences in patient populations, diagnostic tools, and disease severity. Identified risk factors include female gender, social isolation, smoking, low BMI, comorbidities, and systemic inflammation. These comorbidities are associated with increased exacerbations, higher hospitalization rates, and poorer clinical outcomes. While inhaled therapies may have limited impact on psychiatric symptoms, antidepressants must be used cautiously. Non-pharmacological interventions, including pulmonary rehabilitation, cognitive-behavioral therapy, physical activity, and social support, demonstrate clear benefits. Conclusions: Effective management of COPD requires integrated approaches that address both pulmonary and psychiatric components. Tailored interventions can improve clinical outcomes and quality of life. This review explores the bidirectional relationship between COPD and psychiatric disorders, aiming to highlight risk factors, diagnostic tools, and both pharmacological and non-pharmacological treatment strategies.

Keywords: COPD; antidepressants; anxiety; depression; pulmonary disease.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Diagram showing risk factors of comorbid depression and anxiety in patients with COPD.
Figure 2
Figure 2
Shared pathophysiological mechanisms linking COPD with depression and anxiety.
Figure 3
Figure 3
Diagram showing pharmacological and non-pharmacological therapeutic strategies in COPD patients with comorbid depression and anxiety.
See this image and copyright information in PMC

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