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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Individuals with COPD have a higher prevalence of co-morbid depression than either the general population or patients with other chronic illnesses. The best estimates report a prevalence of approximately 40% in COPD patients, compared to 15% in the general population. Depression in COPD patients leads to a lower quality of life, greater objective impairment in function, and decreased adherence to therapeutic interventions. While many depressed COPD patients have been treated empirically with antidepressants--subjecting them to antidepressant side effects, toxicities, and costs--there is a surprising lack of evidence supporting or directing that treatment. We review the current literature regarding the management of depression in COPD, suggest strategies for management, and future research needs.
COPD 2005 Mar
PMID:Current perspectives on management of co-morbid depression in COPD. 1713 80

The aim of this study was to compare the effects of interval training (3-min intervals) with continuous training on peak exercise capacity (W peak), physiological response, functional capacity, dyspnoea, mental health and health-related quality of life (HRQoL) in patients with moderate or severe COPD. Sixty patients exercised twice weekly for 16 weeks after randomisation to interval- or continuous training. Target intensity was 80% of baseline W peak in the interval group (I-group) and 65% in the continuous group (C-group). Patients were tested by spirometry, ergometer cycle test, cardiopulmonary test and a 12 min walk test. Dyspnoea was measured by the dyspnoea scale from Chronic Obstructive Disease Questionnaire (CRDQ), mental health by Hospital Anxiety and Depression scale (HAD) and HRQoL by the Medical Outcomes Survey Short Form 36 (SF-36). After training, W peak, peak oxygen uptake (VO(2) peak) and exhaled carbon dioxide (VCO(2) peak) increased significantly in both groups, no significant differences between the groups. Minute ventilation (V(E) peak) increased only in the C-group. At identical work rates (isotime) VO(2), VCO(2) and V(E) were significantly more decreased in the I-group than in the C-group (p<0.05). Functional capacity, dyspnoea, mental health, and HRQoL improved significantly in both groups, no difference between the groups. Interval training and continuous training were equally potent in improving peak exercise capacity, functional exercise capacity, dyspnoea, mental health and HRQoL in patients with moderate or severe COPD. At isotime, the physiological response to training differed between the groups, in favour of the interval training.
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PMID:Interval training compared with continuous training in patients with COPD. 1718 53

While depression is a common co-morbid condition among patients with COPD, little is known about predictors or health impact of depression among these patients. To address these gaps in knowledge we conducted a cross-sectional survey of 207 patients with COPD cared for in a network of primary care clinics affiliated with an urban academic health center. A standardized questionnaire was used to measure demographic characteristics, smoking status, co-morbid medical conditions, current medications, self-efficacy, social support, illness intrusiveness, and self-reported health care utilization during the previous 6 months. Depressive symptoms were assessed using the Centers for Epidemiologic Studies-Depression scale. Overall, the prevalence of moderate to high levels of depressive symptoms was 60.4%. In a multivariate analysis independent predictors of depressive symptoms were being a former smoker (OR = 0.41 (95% CI 0.19-0.89)), higher self-efficacy (OR = 0.42 (0.28-0.64)), higher social support (OR = 0.72 (0.52-0.99)), and higher perceived illness intrusiveness (OR = 1.05 (1.02-1.08)). Depressive symptoms were associated with increased physician visits, emergency room visits, and hospitalizations for lung disease. In conclusion, depressive symptoms are common among patients with COPD and associated with an increase in healthcare utilization. These findings suggest that the identification of risk factors for depressive symptoms (e.g., continued smoking) may increase detection and improve management of depression and health outcomes among patients with COPD.
COPD 2007 Mar
PMID:Predictors of depressive symptoms in patients with COPD and health impact. 1736 74

A plain chest X-ray is not useful for the diagnosis of early stage of COPD, but severe COPD has some characteristic radiographic signs. Because of absence of vasculature, radiolucency of lung fields is recognized. Depression and flattening of the diaphragm, tear -drop heart and increase in the retrosternal airspace are detected as signs of lung hyperinflation. High-resolution CT(HRCT) scanning is more sensitive to diagnose of COPD. COPD can be detected as low attenuation area. CT is also useful in classifying patterns of emphysema(centriacinar, panacinar and distal acinar type). Although the assessment of COPD is still limited by MRI, progress of MRI techniques in pulmonary ventilation, such as hyperpolarized noble gas MRI and oxygen enhanced MRI, enabled evaluation of COPD.
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PMID:[Radiological diagnosis --diagnosis and evaluation by chest X ray, chest CT and chest MRI]. 1741 86

COPD as a widespread disease will need much more attention of all health care providers in future. Otherwise COPD could lead to increasing costs, especially caused by the systemic nature of this disease and the large number of comorbidities as well as an increase of morbidity with reduced personal fitness and quality of life. As a result, the occupational and social participation subsequently decrease. Specific diagnostic in rehabilitation shows these consequences and a multimodal, multi-professional therapeutic management can be started. This means an optimized pharmacotherapy, different steps of intensity of indoor or outdoor rehabilitation with a training for patients, withdrawal therapy, psycho-social support and in severe cases non invasive artificial respiration. The indication for rehabilitation and the legal requirements are shown, as well as the ways to get rehabilitation and the possibilities of a rehabilitation chain including rehabilitation follow up and physical training. It has been proved that rehabilitation improves the symptoms of the disease, the personal fitness and the quality of life. Futhermore, rehabilitation reduces the days and the time spent in hospital and eventually reduces fear and depression. Therefore if consequently followed, rehabilitation in COPD is a valid therapeutic measure that can diminish the epidemiologic burden of this widespread disease.
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PMID:[Pulmonary rehabilitation in COPD]. 1754 69

COPD exacerbations often lead to a downward spiral of physical activity. To compensate for the discomfort brought on by exertional dyspnea and the accompanying fatigue, patients with COPD will settle into a sedentary lifestyle that deconditions their bodies, serves to further aggravate breathlessness, and results in a further downward adjustment of physical activity. Progression of COPD imposes profound limitation on activities of daily living and gives rise to anxiety and depression. The distressing symptoms of breathlessness and the perception of these abnormalities by the patient lead to a reduction in health-related quality of life. The clinician's therapeutic interventions have to address these symptom and activity limitations with the goal of improving the patient's quality of life.
COPD 2007 Sep
PMID:How are you doing? What are you doing? Differing perspectives in the assessment of individuals with COPD. 1772 76

Cough is an important defensive pulmonary reflex that removes irritants, fluids, or foreign materials from the airways. However, when cough is exceptionally intense or when it is chronic and/or nonproductive it may require pharmacologic suppression. For many patients, antitussive therapies consist of OTC products with inconsequential efficacies. On the other hand, the prescription antitussive market is dominated by older opioid drugs such as codeine. Unfortunately, "codeine-like" drugs suppress cough at equivalent doses that also often produce significant ancillary liabilities such as GI constipation, sedation, and respiratory depression. Thus, the discovery of a novel and effective antitussive drug with an improved side effect profile relative to codeine would fulfill an unmet clinical need in the treatment of cough. Afferent pulmonary nerves are endowed with a multitude of potential receptor targets, including TRPV1, that could act to attenuate cough. The evidence linking TRPV1 to cough is convincing. TRPV1 receptors are found on sensory respiratory nerves that are important in the generation of the cough reflex. Isolated pulmonary vagal afferent nerves are responsive to TRPV1 stimulation. In vivo, TRPV1 agonists such as capsaicin elicit cough when aerosolized and delivered to the lungs. Pertinent to the debate on the potential use of TRPV1 antagonist as antitussive agents are the observations that airway afferent nerves become hypersensitive in diseased and inflamed lungs. For example, the sensitivity of capsaicin-induced cough responses following upper respiratory tract infection and in airway inflammatory diseases such as asthma and COPD is increased relative to that of control responses. Indeed, we have demonstrated that TRPV1 antagonism can attenuate antigen-induced cough in the allergic guinea pig. However, it remains to be determined if the emerging pharmacologic profile of TRPV1 antagonists will translate into a novel human antitussive drug. Current efforts in clinical validation of TRPV1 antagonists revolve around various pain indications; therefore, clinical evaluation of TRPV1 antagonists as antitussive agents will have to await those outcomes.
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PMID:TRPV1 antagonists as potential antitussive agents. 1792 96

Depression is common in COPD patients. Around 40% are affected by severe depressive symptoms or clinical depression. It is not easy to diagnose depression in COPD patients because of overlapping symptoms between COPD and depression. However, the six-item Hamilton Depression Subscale appears to be a useful screening tool. Quality of life is strongly impaired in COPD patients and patients' quality of life emerges to be more correlated with the presence of depressive symptoms than with the severity of COPD. Nortriptyline and imipramine are effective in the treatment of depression, but little is known about the usefulness of newer antidepressants. In patients with milder depression, pulmonary rehabilitation as well as cognitive-behavioral therapy are effective. Little is known about the long-term outcome in COPD patients with co-morbid depression. Preliminary data suggest that co-morbid depression may be an independent protector for mortality.
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PMID:Depression in COPD--management and quality of life considerations. 1804 68

This paper explores the recent literature surrounding comorbid depression and COPD. The literature reveals a high prevalence of depression in patients with COPD and some evidence that the depression is a result of the disease. The literature highlights the negative impact of depression on quality of life and a possible impact on mortality. Depression also negatively impacts on compliance and smoking cessation. Treatment of depression in COPD, particularly by cognitive behavioral therapy, has positive impact on quality of life. Tricyclic antidepressants have a positive impact on mood and COPD, but side effects limit their use. The advent of the new antidepressants may improve acceptability and outcomes, but the research is yet to be undertaken. Physical rehabilitation may have a positive impact on mood. This paper highlights the difficulty in screening for depression in patients with COPD due to the overlap of symptoms between the two diseases. Despite the difficulties, it is important to recognize and treat depression in patients with COPD because of the significant likelihood of improvement in quality of life.
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PMID:Depression in the patient with COPD. 1804 3

There is significant evidence supporting an increased prevalence of depression in patients with COPD, but that depression is not a homogenous entity because there are multiple contributing etiologies for the depressive symptoms. Additionally the relationship between COPD and depression is neither exclusively linear, nor unidirectional. "Early onset" depression is defined as depression that develops prior to the diagnosis of COPD, often during an individual's youth. This is often reflective of a genetic vulnerability to depression which increases adolescents' risk for developing addiction to nicotine, setting up a life-long exposure to tobacco--the single greatest risk factor for the development of COPD. When COPD does develop it brings with it attendant losses, particularly in level of independent function and self image that contribute to a "reactive" depression that is not distinct from the losses experienced by those suffering with other chronic illnesses. Lastly there is increasing evidence through magnetic resonance imaging (MRI) and biochemical markers that systemic, physiologic changes associated with COPD have direct effects on the brain's vasculature that have also been associated with depression in the elderly, termed "late onset" depression. The conclusion is that the presence of depression in a COPD patient does not reflect a single pathologic pathway. Rather the two disorders each contribute to the morbidity of the other. This review discusses the evidence supporting each of these contributors and suggests that an understanding of these varying elements can direct healthcare interventions.
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PMID:A review of etiologies of depression in COPD. 1826 23


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