Anxiety and Depression in Lung Disease
As many as 75 % of patients with advanced COPD have trouble with anxiety and depression. Although not as well studied, the same appears to be true for other advanced lung diseases.
The reasons are two-fold. One is what is called “situational” anxiety and depression. Advanced lung disease takes away a great deal of a patient’s functional abilities. These limitations create anxiety for a patient when he/she can’t take care of basic needs. For example, if a patient does not have “the wind” to make a decent meal, it can be very stressful. When a patient’s lifestyle and activities are limited by their disease, it can be depressing. If for example, a patient can’t travel to see loved ones, it can be disheartening. The “situation(s)” that chronic lung diseases create, could lead any person to feel “nervous”, or somewhat “hopeless”.
The other reason patients with advanced lung disease feel anxious and depressed, is “physiological”. That means that there are physical changes in the body and brain that cause the feelings of anxiety and depression. Let’s put it this way. When humans are in a smoke filled room, and can’t get enough good air, they get very anxious, and may even panic. Understandable, right? It is a normal “physiologic” response. The anxiety gets them going and hopefully moves them to get to safety rapidly. Well similarly, in advanced lung disease, the body often senses it’s not getting enough air, and in response, the brain makes anxiety chemicals (neurotransmitters), and sends nerve signals of panic. Hence, advanced lung disease patients are often “geered up”, and anxious. This is especially true when they are having more trouble with their disease, that is, when they are in “exacerbation”.
After a time of being very anxious from not being able to breathe, the body runs out of the “excitatory” chemicals. This situation leads to a type of “chemical” depression, a feeling of no “get up and go”. This cycle of anxiety and depression can repeat itself over and over again in a vicious cycle.
How to Combat Anxiety & Depression
So what can we do about such vexing emotional states caused by lung disease? Well, first off, it helps patients immensely to know that these unwanted feelings are really not their fault, and such emotions are very common, a part of the disease process, in fact. Such knowledge can also help family members, and friends. Support groups, outside of the family, can additionally bolster patients against these emotional challenges. The American Lung Association (www.lungusa.org/associations/charters/plains-gulf/) usually provides the best local contact point for such.
A program called “pulmonary rehabilitation” (PR) can be highly effective in combating these emotions. Pulmonary rehab was designed, as far back as the 1960s, to help patients with advanced lung disease gain functional ability, through exercise and training patients to work with their limitations. Knowing that patients can “fight back” against the disease, by building strength and endurance, as well as using breathing and other special techniques, is empowering, and very helpful against situational depression.
Exercise, itself, produces some physical effects that combat anxiety and depression. An added benefit of PR is the emotional support, and encouragement that the individual rehab centers provide. Our group works with a number of these outstanding facilities in the Houston area. Finally, occasionally physicians will prescribe medication that can help manage these emotions to great effect.
So in summary, anxiety and depression are common in advanced lung disease, but there are effective strategies to combat these twin scourges. So hope, and know that hope, of and by itself, is strong medicine.