Depression and anxiety in COPD increases morbidity and mortality, study shows

Many patients with chronic obstructive pulmonary disease (COPD) feel depressed or anxious due to their disease.  It is important for physicians to recognize and treat this, because studies sow COPD patients who are anxious or depressed have a 1.25% greater risk of dying compared to COPD patients who are not depressed.

It makes sense that so many patients with COPD become depressed, considering the disease affects so many different areas of their lives.  For instance, according to Peian et al:

• They feel useless
• Experience reduced sexual activity
• Depend on others for their personal care
• Lose interest in future projects

Peain also reports:

Tobacco may provide psychological relief for some individuals.  Continuing smokers with COPD are more at risk of depression than those who quit.  A longitudinal cohort study showed that continuous smokers had a much steeper decline in lung function than those who stopped smoking.  We also found that with an increasing duration of smoking and the amount of smoking, the number of deaths was increased.  These results may be attributed to the interaction between depression and smoking.  Furthermore, there was an interaction between former smoking and depression, which may be due to short duration of quitting.  Most of te former smokers quit only when they suffered from a serious condition.  In addition, smoking cessation was reported to be associated with an increased rate of depression.  These results suggest that COPD patients should stop smoking as soon as possible.

Likewise, the study reported on anxiety.

Elevated anxiety in cOPD patietns is more common in current smokers than in nonsmokers.  Smoking is a common reason to explain the high association of anxiety with COPD.  Tobacco use is widely acknowledged as the single most important environmental risk factor for the development of COPD, and a high level of anxiety is a risk factor for starting to smoke.  A roportion of patients who develop COPD as a consequence of smoking show higher levels of anxiety than in the general population.  Taken together, it is likely that there is an interaction between current smoking and anxiety.   In fact, our study shows that this interaction is increased with a long duration of smoking and a large number of pack-years. 

The study further concluded that 48-60% of th deaths in COPD subjects were explained by an interaction between smoking and depression symptoms, and 49-55% of the deaths of COPD subjects were explained by an interaction between smoking and anxiety symptoms."

Bottom line, the researchers suggest that "quitting smoking may help depressed or anxious patients with COPD forestall death.  Given the difficulty in the treatment of depression or anxiety in certain COPD patients, a recommendation to quit smoking may be an inexpensive and practical means of delaying death from COPD."

References:

1. Lou, Peian, Peipei Chen, Pan Zhang, Jiaxi Yu, Yong Wang, Na Chen, Lei Zhang, Hongmin Wu, and Jing Zhao, “Effects of Smoking, Depression and Anxiety on Mortality of COPD Patients: A Prospective Study,” Respiratory Care, January, 2014, Volume 59, Number 1, pages 54-61

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Depression often goes undiagnosed

One of the dumbest and least successful ways of committing suicide is by taking pills.  Surely it works sometimes, but more often than not someone will come around and find your butt and call an ambulance.  You'll end up in an emergency room. 

The same is true for alcohol abuse.  You end up in the emergency room, and you will be poked, prodded, puked, and maybe even tubed.  Doctors and nurses like to make you as miserable as possible so you don't do such a dunderhead thing again. 

Then when you are better you will end up in the psych unit at some hospital, and you will have to see a psychiatrist or psychologist.  You will be required to sit through counseling sessions.  Yes, you will be forfeiting some of your freedoms.  Whether this is right or not can be debated later. You will, hopefully, benefit as a result and hopefully not try to kill yourself again.

Hopefully you will realize that depression is a disease that can be treated.  It's normal to be depressed.  It's okay.  So don't take your life.  It's not worth it.  It's special.  Your life is special.  Your life is a gift.  You are a gift. You are special.  You are loved by someone, and that person will miss you. That person may blame himself.

But in your depression you probably fail to think how others think.  You may not care.  And you might take the misery the nurse and doctor put you through and make sure you do it right the next time.  But if you don't do it right, chances are that your doctors and nurses will simply think you are seeking attention.  And you will get attention in the psyche unit. Or, perhaps you ARE seeking attention.

And I don't think the psych unit is a bad thing.  Honestly, depression is a disease that can be treated.  And, while many people make fun of psych units, they are good.  They do good things.

Depression might simply be the most under diagnosed disease in the world.  It is because most often it goes unrecognized, and on the other hand the patient who is depressed is too embarrassed to say anything.  So the cycle continues.

Surely there are those people who abuse the system.  But for the other 80 percent, I think we need to take you more seriously.  I think we need to not throw everything at you. I think we ought to have a little more empathy, and treat you with respect and dignity (the way we'd treat you if you were one of us in trouble). 

I think one of the roles of respiratory therapists, nurses, and physicians should be to watch for the markers of depression, and a common one is silence.  We ought to do our part in trying to address this however we can, and perhaps the best remedy is kindness on our part.

Note: There was no research into this article.  This is merely an opinion. 

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Depressed spouses make themselves sick?

One of the most frustrating things I see in the hospital is when we have an older patient whose spouse just died and the couple had been happily married for over 40 years. We had one man recently who was a very successful member of the community even up until recently.

However his wife died a couple weeks ago, and then he became so depressed he ended up a permanent fixture in the hospital. He got pneumonia, he refused to eat, his medical condition deteriorated, he ended up on a ventilator, and he eventually made it back to the floors and continued to be a depressed mess.

I tell you I have the utmost sympathy for people in this situation. However (and I'm no expert in this area other than by mere observation as an RT), I wonder if they have their priorities straight. I know lots of people who were happily married, only to live on for many glorious years after their spouse passed on.

I consider myself happily married, but I sure would hope that if I passed on that my wife would go on with her life after the initial mourning process. I mean, I know their is nothing more difficult than losing a loved one (especially a child), but I can't imagine the one who passed on would want his best friend to spend the rest of her life mourning.

Being old and being fed up with going to the doctor, about being blind and deaf and having to tackle a million prescriptions every day is one thing. I know when my uncle Donald died recently, I was told he had simply decided he had enough, and then he got his wish a few days later. He was 92.

I understand that. But to be of good health, sound mind and body, and to simply give up living, to me, is a foolish thing to do. And, I might wonder, if that person didn't have his or her priorities in life mixed up. I rarely do this in real life, but I would like to ask these people some questions like:

1. Do you believe in God?
2. Do you place God ahead of your wife?
3. Do you have children?
4. If so, do you prioritize your yourself over your children?
5. Do you have hobbies that you like to enjoy that you can still do?
6. Were you so attached to your wife that her love was the only quality thing in your life?
7. Do you have quality friends?
8. If so, do you place your grief ahead of your quality friends?
9. Do you not care that you are setting a bad example for the ones who still love you?
10. Do you not think you are letting your freinds and family members down by giving up?
11. Do you not care what other people think?
12. Do you realize people feel sorry for you?

Sometimes, when I have time, which often I do here on nights (but not lately), I talk to these patients. I ask them, in an appropriate way (and only when they bring up the topic), the above questions, and sometimes I get them to participate in an intelligent discussion during the treatment. I get them talking about how wonderful his wife was, or career, or something.

And, more often than not, I get a smile. The reason, I think, is that, even while he is depressed, he doesn't want to be a stick in the mud; he doesn't want to share his depression; he understands that there are other people (like me) who still have several quality years of life left.

So they smile. And, I bet more often than not, they eventually recuperate. I bet most of them do. But, unfortunately, some never do. These people become permanent fixtures around the hospital and nursing home arenas. They are the ones who demand attention, ring their call bells every 15 minutes chanting to whomever answers the call with: "Get me this," or "get me that."

Those are the lucky ones. Those are the ones who are still willing to talk, because some of these individuals are so depressed they just lie there and sulk. I feel bad for them at first, but then after a while I wish they would just quit feeling sorry for themselves. I wish they had other priorities in their lives other than the one they lost.

I wonder if they do believe in God. I wonder if they do believe in heaven. Because, as I wrote before, I believe that people that have their priorities together are the best patients. In fact, I bet most of these people don't get sick and avoid the hospital altogether.

I'm no expert in this area, yet here I am just wondering.