COPD Patients Often Treated for Depression and Anxiety, Study Finds

Antidepressants and anti-anxiety medications are often prescribed to people with chronic obstructive pulmonary disease (COPD), pointing to a higher risk of psychiatric and mental health problems in this patient group, a large Dutch database study reported.

These findings, its researchers noted, indicate that depression and anxiety are more common among people with COPD than those with other chronic illnesses, including rheumatoid arthritis and diabetes. Only people with skin disorders like eczema and psoriasis were seen to be slightly more frequent users of these medications.

The study, “Higher prescription of antidepressants and/or anxiolytics among chronic obstructive pulmonary disease patients,” was published in the journal Therapeutic Advances in Respiratory Disease.

COPD is often accompanied by problems such as depression and anxiety, affecting both treatment outcomes and mortality. However, there is not much evidence on the number of COPD patients using medications to treat these conditions.

Researchers at Amsterdam and Utrecht universities in the Netherlands examined the NControl database, which contains the prescription data of 800 pharmacies and 7 million individuals. Their main goal was to compare the use of chronic medications for depression (antidepressants) and anxiety (anxiolytics) between COPD patients and people with or without other chronic diseases between 2013 and 2019.

The study included data from adults, ages 55 and older, given frequent prescriptions — at least two prescriptions each year, in five out of the six years studied — for COPD (96,319 patients), heart disease (422,376 patients), type 2 diabetes (165,975 patients), rheumatoid arthritis (7,900 patients), and skin disorders (62,865 patients).

A separate control group of almost 3.3 million people, over the age of 55 and not in any of these five chronic disease groups, was also included. Of these people, 757,947 individuals given frequent prescriptions of any kind were evaluated as a sub-control group.

Results showed that 14,619 (15.2%) of the patients being treated for COPD, 9,627 (15.3%) of those treated for skin diseases, 1,042 (13.2%) on disease-modifying anti-rheumatic drugs (DMARDs), 49,203 (11.6%) on cholesterol-lowering medication (statins), and 18,955 (11.4%) on glucose-lowering therapies for diabetes were also being chronically treated for depression or anxiety.

In contrast, 86,407 (2.6%) people in the overall control group and 86,407 (11.4%) in the sub-control group were chronically treated for these psychiatric disorders.

The risk among the COPD patients for chronic use of antidepressants and anxiolytics was nearly six times higher (5.8 times) compared with the overall control group. It was also much higher than in any other chronic disease group, apart from that encompassing skin disorders (5.85 times higher).

“Several factors are thought to contribute to the development of anxiety and depression in COPD specifically, including smoking, hypoxemia, systemic inflammation and the chronic use of corticosteroids,” the researchers wrote.

Analyses also showed that men with COPD were more likely than women to receive these medications (6.37 vs. 5.54 times more likely). Risk also with age, and patients 75 or older were at a higher risk (6.43 times higher) of using these medications than younger age groups (5.68 for individuals ages 55–65, and 5.66 for those ages 65–75).

Compared with the sub-control group, the risk of antidepressants and anxiolytic use for COPD patients was 1.33 times higher, while for other chronic disease groups it ranged between 1 to 1.34 times higher. Across all five chronic disorders, there was an increased risk for women compared with men.

The study had several limitations, the researchers noted, including the possible inclusion of asthma cases in the COPD  group due to treatment overlap, not accounting for possible confounding factors related to diet and lifestyle, and the lack of information regarding the onset of anxiety and depression (before or after COPD diagnosis).

“In a follow-up cohort study, more research on incidence, causes and prognosis should be performed to, among other things, elaborate this,” the researchers wrote.

Nonetheless, these findings demonstrated “the risk of depression and/or anxiety was increased in COPD patients,” they added.

“Among users of other chronic medication, the risk was also one of the highest. These data contribute to the awareness and acknowledgement of the increased risk of mental health issues in COPD patients which are known to hamper treatment outcomes significantly,” they concluded.