How State of Mind Affects COPD

How COPD and Mental Health Are Linked

Living with COPD can put you at risk of depression and anxiety for various reasons. The lung condition may take a toll on your energy, sleep, social life, and self-esteem. And naturally, COPD symptoms like shortness of breath can be stressful and frightening.    

 Mental health conditions can also impact your COPD. For instance, depression may drain your resolve to follow your COPD treatment plan, eat well, and exercise. Anxiety or panic attacks could do the same. They also might bring on shortness of breath or cause you to breathe differently than usual, giving you even more anxiety. 

"Our minds have a huge effect on how our bodies respond to what's happening and on what we think about in terms of what's happening to us," says Julie Shafer, PhD, a psychologist in private practice in Oak Grove, Oregon. "If you address depression or anxiety directly, then that will make life a little better."

It might even save your life. Research has shown that people with COPD are nearly twice as likely to die by suicide than others. 

Why Mental Health Care Is Key  

Along with easing your mind, treatment for depression or anxiety might improve your COPD symptoms. 

 "We definitely see a lot of improvements in symptoms when we treat depression and anxiety," says Michelle Eakin, PhD, associate professor of medicine in the pulmonary and critical care medicine department at Johns Hopkins Medicine in Baltimore. "We have seen improvements in overall quality of life." 

Doctors know that both depression and anxiety are linked to worse long-term outcomes for people with COPD. But, Eakin says, it’s unclear whether treatment for depression or anxiety can lead to fewer COPD flare-ups, or exacerbations, that send you to the hospital or emergency room. 

"We just don't know enough about COPD exacerbations alone to really know about that," Eakin says. 

How Talk Therapy Can Help  

Talk therapy is a common treatment for both anxiety and depression. You meet with a mental health professional, like a therapist or a psychologist, who teaches you how to spot and change troubling thoughts. A type of talk therapy called cognitive behavioral therapy (CBT) may be especially helpful when COPD symptoms lead to runaway thoughts that make you anxious or depressed.

 "Cognitive behavioral therapy can be quite helpful with the goal of reducing depression and anxiety and improving coping and quality of life," says Jean Crowell Beckham, PhD, professor of psychiatry and behavioral sciences at the Duke University School of Medicine.

 "What CBT does," Shafer says, "is it helps the person look at the specific things that are happening, how they're interpreting those things, and whether they can interpret it in a way that's less catastrophic, less depression-inducing, and more based in reality."

 CBT thinking skills can come in handy if you’re also getting pulmonary rehabilitation, which can be challenging and stressful for some, Shafer says. The skills you might learn through CBT can help you participate more fully and benefit more from pulmonary rehab, Eakin says.

 When you're choosing a mental health care provider, aim to find someone who's worked in a medical setting with people who have long-term lung conditions, Shafer says. That way, your provider will have a better understanding of what you're going through and how COPD can change over time. 

"Being familiar with how chronic diseases affect people emotionally is really important," she says.

Relaxation Techniques for COPD Symptom Relief

During talk therapy, your mental health provider also might teach you relaxation techniques to ease stress, depression, or anxiety. For instance, Beckham recommends regularly practicing techniques like mindfulness and meditation. 

Shafer has taught some of her patients with lung conditions a technique called progressive muscle relaxation. It involves tightening, then relaxing, one muscle group at a time. 

"When we're anxious or depressed, we're going to hold a lot of tension in our body,” she says. “That tension is going to take energy, it's going to take oxygen, and it's going to make you more susceptible to running out of breath."

Tuning in to the body parts where you're tense, she says, can help you relax and have more energy to spend on things you enjoy. 

Doing controlled breathing exercises anytime you start to have feelings of breathlessness can help ease feelings of anxiety, too, Eakin says. It could slow down racing thoughts and worries, and help you avoid reading too much into common COPD symptoms.

What to Know About Depression and Anxiety Meds

When you get help for depression or anxiety, your doctor or a psychiatrist might recommend medicines such as antidepressants. In particular, antidepressants called selective serotonin reuptake inhibitors (SSRIs) can boost quality of life and improve breathing and fatigue, research shows.

 But SSRIs and another type of antidepressant called serotonin-norepinephrine reuptake inhibitors (SNRIs) also have been linked with higher rates of complications in some older adults with COPD. 

Before you start taking medicine for depression or anxiety, ask your doctor about the possible side effects. And tell them about any other medicines or supplements you take, so they can make sure those won’t interact with your depression or anxiety medicine. 

Whether you're curious about trying talk therapy or medications, the key is to reach out for help. Start by having a conversation with your primary care doctor about what's been going on with your mental health, Eakin says. Your doctor can point you to local resources and refer you to a mental health provider. 

"It's worth the time and effort to talk about it and see what's available out there," she says.