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Overcoming Anxiety and Depression

According to a review of current literature, “Anxiety and Depression in Patients with Chronic Obstructive Pulmonary Disease (COPD) — A Review,” roughly 50 percent of people living with COPD exhibit symptoms of anxiety and depression.

Symptoms of anxiety and depression include fatigue, loss of interest, persistent sad, anxious or “empty” mood, and various physical symptoms that do not respond to treatment and are often characterized by a person’s inability to work, sleep, study, eat, or enjoy once-pleasurable activities. However, for people living with COPD and other chronic lung conditions, such as emphysema and chronic bronchitis, these symptoms can have more serious effects.

“The social isolation that comes with anxiety and depression combined with the immobility that many patients experience often results in a loss of muscle bulk,” said Daniel Dilling, M.D., associate professor of medicine at Loyola University Chicago Stritch School of Medicine, medical director of the lung transplant program at Loyola School of Medicine, medical director of the medical intensive care unit, and medical director of respiratory care at RML Specialty Hospital in Hinsdale, Ill. “This leads people to be more deconditioned and more short of breath and, as a result, more isolated and more depressed.”

According to Dr. Dilling, this cycle is very common for people who have been diagnosed with chronic lung conditions and only becomes worse as the disease becomes more severe.

“All of these things feed on one another in very negative ways,” said Dr. Dilling. “If you become more depressed, you isolate yourself more and you become even more deconditioned and this makes you weaker and short of breath. It cycles the disease in a very negative way.”

However, treatment is available and has been proven to improve both the physical and psychological state of patients. These treatments include cognitive behavioral therapy, pharmacological treatments, relaxation therapy and pulmonary rehabilitation. 

“I think the most important, most beneficial and most underutilized treatment for COPD and emphysema—and specifically the depression and anxiety that goes along with it—is pulmonary rehabilitation,” said Dr. Dilling. “Pulmonary rehab has been shown in multiple studies to improve the depression and anxiety associated with emphysema, and I think it does more for those symptoms than any kind of medication we might try.”

A broad program that helps to improve the lifestyle and wellbeing of people living with chronic lung conditions, pulmonary rehabilitation can be used in conjunction with medical therapy and includes exercise training, nutritional counseling, education, and psychological counseling and/or group support.

“Pulmonary rehabilitation provides patients with a supervised exercise program that can be completed at an out-patient facility two to three days a week for up to three hours per day,” said Dr. Dilling. “During this time, they are monitored by a respiratory therapist, a physical therapist and an occupational therapist. This will often also include some group therapy, whether that be for learning mastery of the disease or for talking about some of the emotional and psychological aspects of the disease.” 

Dr. Dilling notes that medication directed at anxiety and depression may also be helpful and should be considered, with counsel from a physician, in addition to pulmonary rehabilitation.

“These kinds of medications can be useful. However, I try to use them sparingly,” said Dr. Dilling. “I think it’s the most common reaction to want to give someone a pill for a symptom or a disease, but I think especially in this case there might be other options to pursue first that might be more helpful and won’t include taking a medication.”

For more information on pulmonary rehabilitation and to find a program near you, visit the American Association or Cardiovascular and Pulmonary Rehabilitation website (www.aacvpr.org). Pulmonary rehabilitation benefits are available through most major insurance companies. 

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