How antidepressants could affect COPD
Managing your condition can be complicated; it’s important to find the best treatments for you
There’s growing appreciation of how complex chronic obstructive pulmonary disease (COPD) is and how many symptoms it can involve.
This condition is often progressive. It narrows and destroys the airways, which leads to trouble breathing and recurrent coughing. Emphysema and chronic bronchitis are other names for COPD. Smoking is the most common cause for COPD in North America. COPD affects more than 10 per cent of people over the age of 40 around the world. About 70 per cent of this population also experiences low mood and anxiety.
If you’ve got this lung condition and you’re on an antidepressant, it’s worth paying extra attention to your pulmonary symptoms.
Antidepressants can make you feel sleepy or nauseous, which could then impact your breathing and your lungs. They may also affect your immune system, which could raise your risk of developing infection and breathing issues.
I’m a respirologist — a lung doctor — and I also specialize in sleep medicine. I see many patients who have chronic lung disease, including a large number who are also on pills for anxiety and depression and often on more than one of these kinds of medications at a time.
That observation led me to study the effects those medications have on people who have COPD.
For example, among people with COPD aged 66 and older who use a kind of medication called a serotonergic antidepressant, we found a 15-percent increase in the likelihood of hospitalization when compared to people who weren’t taking these types of pills.
Among the same group, we also saw a 20-per-cent increase in the likelihood of death, including dying from breathing issues.
Serotonergic antidepressant drugs are a first-line drug therapy for anxiety and depression. They’re also used sometimes as off-label therapy for insomnia or to help treat chronic pain. As well, SSRIs and SNRIs are sometimes prescribed to help manage breathlessness that’s hard to control, even with an inhaler.
Two types of medication fall into this category: selective serotonin reuptake inhibitors (SSRIs) like citalopram, paroxetine or serotonin, and norepinephrine reuptake inhibitors (SNRIs) like venlafaxine or duloxetine.
In an earlier study, my team also showed that another kind of psychoactive drug called benzodiazepines such as lorazepam or clonazepam has similar negative outcomes. There are many reasons someone with COPD might need prescriptions for these kinds of medicine. In addition to causing respiratory problems, COPD is also associated with chronic pain, poor sleep, anxiety and depression. These problems can feed into — and magnify — one another.
Although my team’s research showed an association between COPD, serotonergic medications and higher chances of being hospitalized or dying, we can’t conclude a definite causeand-effect relationship.
My hope is that people with COPD who use these drugs — and their doctors — will be more vigilant about monitoring for adverse side effects. I also hope it can open the door to more discussions about other treatment options.
If you’re being prescribed these kinds of pills for the first time, ask your doctor about non-drug treatment options.
For depression and anxiety, psychotherapy — also known as talk therapy — can be a good option. There are several different methods and techniques used in this kind of treatment, all aimed at supporting your well-being. Psychotherapy may be offered by a doctor or by a variety of specially-trained allied health professionals including social workers, nurses, occupational therapists, psychologists or psychotherapists.
Pulmonary rehabilitation may also help many different types of symptoms in COPD. It combines structured, supervised physiotherapy with education and psychotherapy. In addition to helping decrease your breathlessness, pulmonary rehab can also be a benefit to your mental health. Exercise itself is known to have mood- boosting effects. You will need a referral from your doctor for these types of treatment. Provincial health plans generally cover these services.
Although psychotherapy and pulmonary rehabilitation are great first options before moving onto psychoactive drugs, it can be difficult to access these services and they can have long wait lists. Managing COPD can be complex and when you’re working with your care team to find the best combination of treatments for you, it’s important to educate yourself about the risks and benefits of various therapies — and their alternatives.
Dr. Nick Vozoris is an assistant professor in the Division of Respirology at the University of Toronto’s Faculty of Medicine. He is also a staff respirologist at St. Michael’s Hospital and an associate scientist at the Li Ka Shing Knowledge Institute.