Sue Binnall, 61, a former administrative assistant and a grandmother of eight with a big laugh, always had been independent and upbeat. Then came a diagnosis in 1995 of chronic obstructive pulmonary disease. In 2000, after treatment for breast cancer, her COPD worsened, forcing her to use round-the-clock supplemental oxygen. Her doctors told her she had a genetic form of COPD known as alpha-1 antitrypsin deficiency (alpha-1), or inherited emphysema.
“I was still suffering the downside of cancer,” she says. “And then I was hit with alpha-1.” Binnall became depressed and began to spend days sitting and crying, not caring if her house was clean. Such feelings of sadness are common among people with COPD.
Between 28 percent and 42 percent of people with COPD suffer from depression, more than the nearly 7 percent among the general population, notes Dr. Nicola Hanania, associate professor of medicine at Baylor College of Medicine in Houston, Texas.
Anxiety is even more common, says Dr. Paul A. Pirraglia, assistant professor of medicine at Brown University in Providence, R.I., whose study of COPD, depression and anxiety appears in a 2011 issue of Journal of Psychosomatic Research. One-third to one-half of people with COPD experience anxiety, and sometimes anxiety and depression overlap, Pirraglia says.
Depression isn’t correlated with the severity of lung disease, however. It’s the fatigue and restriction brought about by lung disease—moderate or severe—that increases the likelihood of depression. “We found a link between fatigue and quality of life,” says Hanania, referring to his study on depression and COPD. “COPD patients get fatigued and so do depressed people. In those with COPD, inability to exercise, lifestyle changes and fatigue all contribute.”
For COPD patients, almost any activity can lead to breathlessness—walking, socializing with friends, even eating—adding to depression and anxiety, says Kim Lebowitz Feingold, a psychologist at Northwestern Memorial Hospital in Chicago. “When someone feels short of breath, it’s scary,” she says. “That anxiety causes physical arousal that leads to chest tightness and increased breathing demands. So patients avoid exertion.”
Help is available
Fortunately, both depression and anxiety can be treated. The options include:
Antidepressants. Binnall’s doctor prescribed an antidepressant. “I noticed a difference,” Binnall says. “I’d get up and be with my grandchildren more.”
Talk therapy. Binnall also visited a psychotherapist at least every two weeks. “I could get out my frustration that my husband didn’t go to the doctor with me and that my daughter moved to South Carolina,” she recalls. “I felt they were deserting me. But now I realize that they weren’t doing these things to be vindictive. I can deal better.”
That sort of reframing of a situation, often the thrust of cognitive behavioral therapy, can help. “You gain an understanding of how to respond to things that allows you to cope better with depression,” Pirraglia says.
A behavioral therapist also can teach important relaxation and breathing techniques, Feingold says. People with COPD tend to breathe shallowly, which can lead to rapid breathing, lightheadedness and anxiety. But you can learn to breathe more deeply by inhaling, letting the belly fill, expanding the diaphragm, then exhaling, relaxing the stomach.
Support groups. Binnall joined an alpha-1 support group that offered education and access to others with the disease. “I knew if I was having a bad time, I could call someone who was in the same predicament I was,” she says.
Pulmonary rehabilitation and exercise. Pulmonary rehabilitation sessions can offer both exercise and information. “We talk to patients about thinking creatively about what they can and can’t do,” Pirraglia says. For instance, if a patient loves to garden, he could have a family member help build the garden off the ground so he won’t have to bend over, which can limit breathing. “It’s part of reframing your response to COPD.”
Regular exercise also can be helpful. “People feel better, have less shortness of breath, and show improvements in depression scores,” Pirraglia adds.
Binnall agrees, having worked with an exercise trainer familiar with COPD. “I worked up to 30 minutes on the treadmill and 30 on an upright bike three days a week, and worked on weight machines,” she says. “After a couple of months, I felt better because I could do things for myself. That felt great.”