It is widely agreed that there is a strong relationship between COPD and depression. It is also widely accepted that many questions remain regarding the complex nature of that relationship. For example, how do depression and anxiety interact with smoking to affect COPD mortality rates? One certainty is that people with COPD and depression/anxiety are less likely to adhere to treatment and more likely to experience exacerbations of the disease, making the downward spiral of COPD symptoms harder to treat. This short article looks at the interface of COPD and depression and reviews possible interventions.

The depression-COPD treatment dynamic

In a 2020 Dovepress study, researchers summarized the findings of a review of 20+ quantitative studies of depression and COPD. “The relationship between depression and treatment adherence was significant and negative,” it said.

26%-43% graphic

The range of COPD patients who also experience anxiety and depression

A 2020 Dovepress literature review stated that depression and anxiety co-occur in up to 43% of all people with COPD. The report added that “anxiety and depressive symptomatology have an impact on COPD exacerbations and mortality.”

Equally important was the study’s finding that “adherence to rehabilitation and antidepressant pharmacological treatments in depressed patients was linked to a decreased risk of hospitalization….depressed patients compliant with an antidepressant were [also] more likely to adhere to COPD maintenance inhalers.”

The dynamic between depression and COPD becomes clear: Depression often inhibits adherence to COPD treatment, yet adherence is essential to reducing risks for the patient.

Likelihood of depressed COPD patients to be noncompliant with medication

300%

“Depressed COPD patients are 3 times more likely to be non-compliant with prescribed medication,” reported a 2020 Dovepress study. But, as the authors added, “exercise, diet, and health-related behavior” are also affected.

Consensus around interventions

An earlier 2016 Dovepress study acknowledged that “anxiety and depression are remarkably common in COPD patients, but the evidence about optimal approaches for managing psychological comorbidities in COPD remains unclear and largely speculative.” The study noted that:

SSRIs have taken the place of trycyclic antidepressants. A 2012 Respirology study of treatment for anxiety and depression in patients with COPD reported that “SSRIs are generally considered as preferred first-line agents for control of depressive symptoms in patients with COPD, with some evidence pointing to better depression scores and quality-of-life outcomes.” Other studies have noted that SSRIs are linked to fewer side effects, which tends to enhance compliance.

Cognitive behavioral therapy (CBT) is the most common action. CBT can work individually or in groups. It “focuses on helping patients discover alternative solutions and promote more adaptive coping styles in order to overcome adversities.” Furthermore, CBT’s effectiveness in alleviating symptoms of depression and anxiety is enhanced by exercise and education.

Pulmonary rehabilitation (PR). This form of treatment for COPD is proven to reduce anxiety and depressive symptoms through progressive exercise, breathing techniques, and education. The psychological benefit is also related to the stress-reducing impact of physical activity and the “sense of self mastery” that emerges through successfully applied effort.

“The mind is powerful, and education can be an amazing fix. A lot of success depends on changing the thinking involved.”

Abby Conway, RN, BSN, MSN, SeniorBridge Associate Director

The role of medically directed home care in COPD management

As patients with COPD navigate the journey of their disease, keeping them safe, stable, and empowered will continue to be the task of home care professionals. Based on SeniorBridge experience, these core practices are most effective.

Building trust. “It’s important to build a relationship,” said Abby Conway, a SeniorBridge RN with extensive COPD treatment experience. “If the client trusts you, then they’re more likely to plan with you and stick with the plan.”

Psychosocial care. “LCSWs can make a huge difference,” according to Conway. “They can help with counseling, connecting clients to resources, helping family caregivers, and just by listening to the person with the disease. Holistic care means psychosocial as well as clinical.”

Being an extension of the physician’s care. Medically directed home care – under the supervision of an RN – can extend the influence and impact of the patient’s pulmonologist. “We work with the doctor to chart treatment, reconcile medications, and keep everything on track,” said Conway. “We also monitor changes constantly so we can report on what’s working.” Evidence has shown that “home-based pulmonary rehabilitation programs represent effective therapeutic intervention approaches for relieving COPD-associated respiratory symptoms” as well as quality of life and exercise capacity.”

In summary, untying the knot of mental health and COPD management may require interventions on multiple fronts – and medically directed home care professionals are optimally positioned to help the patient engage in many of them.

The integrated care management model by SeniorBridge

Home care services vary widely in the services they provide.

SeniorBridge offers an integrated care management practice model that involves two components:

  1. Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
  2. A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.

NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.

For more information on medically directed home care, contact SeniorBridge.

Sources consulted:
Dovepress (2021)
Dovepress (2016)
Respirology (2012)
National Library of Medicine (2014)

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