Overcoming Depression In COPD Part I

Vijai P. Sharma, Ph.D

COPD stands for "Chronic Obstructive Pulmonary Disease," a breathing disorder that is progressive and not fully reversible. A disease with that kind of prognosis tends to invite depression and despair, at least in some people.

Depression in people with COPD is reported to be more common than in the general population. Speaking of the general population, 20 million Americans experience a major depressive episode in any given year. Two in 8 young Americans would experience their first episode of depression before age 24. Out of those two, one would experience one or more episodes of depression later in his or her life.

Translation: Even in the general population, 1 in 8 people would experience clinical depression more than once. As for people with COPD, more patients are likely to experience recurrent episodes of depression.

Could the negative impact of COPD on daily functioning be the cause for depression? That should be said for all major chronic illnesses. But the incidence of depression appears to be higher in people with COPD than with those with other major chronic conditions.

Depression is "more prevalent in people with COPD than in people with other chronic conditions, such as heart disease and even cancer," says Dr. Rachel Norwood of the National Jewish Medical and Research Center in Denver. Norwood goes on to say that depression affects almost all people with COPD.

Dr. Vlady Rozenbaum, moderator of COPD-ALERT's online COPD support group once told me personally that everyone he knows with COPD is on some sort of antidepressant.

Why should depression be more prevalent in COPD? Could the higher prevalence may be due to some organic or chemical-reactive component of COPD?

Depression and smoking connection: One such chemical reactive component as identified by Norwood in an interview published in Foothill Pulmonary is the nicotine ingested through smoking. Smokers have a higher rate of depression than individuals in the general population. Norwood calls it the "double-barreled situation." Depressed people tend to smoke, and smoking can cause COPD. Impairment and dysfunction associated with COPD makes a patient even more depressed which leads to more smoking!

According to a recent survey by Mark Kunic and others, anxiety and depressive disorders are found in 60 to 80 percent of military veterans with COPD. Note that the incidence of smoking and mood disorders is significantly higher in VA clinic patients.

Pre-disposition for depression: Since 1 in 4 persons in the general population experience at least one episode of depression, we can assume that there must be a fairly large section of people with COPD who had predisposition to depression from the start. We know that depressed adolescents are more likely to start smoking and continue smoking. Therefore, many depression- predisposed teens start smoking early, get hooked on nicotine and later develop COPD.

Depressive predisposition and nicotine-induced depression: 85% of patients with emphysema had, on average, 10 pack years of smoking before COPD was diagnosed. Norwood points out that MRI studies of the brains of heavy smokers and of depressed patients look very much alike. Can nicotine cause a chemical reaction in the brain leading to depression?

This is another example of the COPD double barrel. People who are predisposed to depression would have additional reinforcement of depression through the use of nicotine. Furthermore, some individuals who were not predisposed to depression might develop depression and COPD in the process of years and years of smoking.

Depression & breathing deficiency connection: We know that people tend to experience breathing difficulties for a long time before they consult a physician and are finally diagnosed with COPD. By the time people are diagnosed with COPD, on average, they have already lost 50% of their lung function!

The brain consumes about 40% of the oxygen we breathe in and there are safeguards to make sure that the brain receives its needed supply. However, it's possible that compromised breathing over time, at least in some cases, creates a chronically diminished supply of oxygen called "hypoxia." Negative physical conditions such as hypoxia, lesions, infarctions, and injuries and insults to the brain are often associated with cognitive impairment and depression.

Compromised breathing may be one of the reasons that the incidence of depression is higher in COPD than in other chronic conditions.

Breathing affects emotions and emotions affect breathing. For example, anxiety and anger associated with accelerated breathing and depression with slumped posture and suppressed breathing.

Now the good news! There is credible scientific evidence that special breathing techniques provide effective treatment for chronic depression. So, breathing habits that can be a cause of mood disorder can also serve as a tool for mood improvement.

I will discuss those breathing studies in a future article.

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Copyright 2005, Mind Publications 
Posted September 2005