Depression Leads to Non-Adherence of COPD Medication

Chronic obstructive pulmonary disease (COPD) is a progressive disease, which currently does not have a cure yet, as modern medicine has not found a way to reverse the damage done to the airways and lungs. For this reason, there is a slow and long-term development of debilitating symptoms. The quality of life can be severely impaired in patients with COPD. Therefore, people who have COPD are prone to the development of depression or manifestations of depressive symptoms. 

A person's quality of life deals with four factors, which include emotional functioning, social role functioning, activities of daily living, and recreational pastimes. The symptoms of COPD slowly develop and worsen over time, which will limit a person’s routine activities and function. By experiencing the effects of COPD, a person’s quality of life is impaired leading to depression. Many physical illnesses are associated with the presence of depressive symptoms, in which many studies have found a high incidence rate of depression and anxiety among patients suffering from COPD.

Depression is common, but serious mood disorders can greatly affect how a person feels, thinks, and handle daily activities. Moreover, COPD management is complex, with patients needing to make behavioral and lifestyle changes such as smoking cessation and adherence to both exercise therapies and optimal medications. Hence, there is a need for COPD patients to discuss their mental state with their doctor. The doctors can help identify if the patients are depressed and will be unable to perform their daily functions leading to medication non-adherence and other therapeutic interventions, which are essential in the management of COPD.

COPD causes lots of changes in the body such as weight loss, sleeping problems, and breathlessness. These physical changes may slowly lead a person to feel frustrated, lost, and sad. In depression, one gets stuck mourning about life. About 40 percent of people who have COPD suffer from depression.

Depression makes the symptoms of COPD even worse. People with COPD may feel low all the time, which makes it difficult for them to follow their treatment plan, forget to take their medications, and not exercising. Turning to alcohol, drugs, and cigarette smoking makes the matter even worse since all three can harm the body.

What are the symptoms of depression?

Discussing your mental state with your doctor can make a difference. Here are some of the common symptoms of depression:

• Easily irritated or being grumpy 
• Continuous crying and sadness for weeks
• Being oversensitive
• Feeling guilty
• Having suicidal thoughts
• Having trouble sleeping (usually due to lack of sleep or tiredness)
• Loss or increased appetite
• Lethargy
• Lack of a positive attitude and no humor

Adherence to COPD Medication

Adherence is defined as “the extent to which a person’s behavior (in terms of taking medications, following diets, or executing lifestyle changes) coincides with medical or health advice.” Adherence to a medication regimen, especially for patients on a long-term pharmacotherapy using repeat prescriptions pose a great challenge and difficulty.

Factors pertaining to the disease, treatment, patient, clinician, and the practice setting have been identified as the determinants or risk factors for non-adherence. COPD patients have been found to be non-adherent with their treatment recommendations both intentionally and unintentionally. Poor adherence to drug therapy and disease management programs have also been identified as the major factors that result in emergency hospitalizations among COPD patients. 

The three classic types of non-adherence to therapy are underuse, improper use, and overuse. The most common type of non-adherence for COPD patients is underuse, which means that there is a reduction of the apparent daily use versus a standard dose of medication that is intended for the treatment of the condition.

Patients are more likely to adhere to treatments when they perceive the recommended treatment according to their personal beliefs about the illness itself and their experiences with their past illnesses or current symptoms. The patients' decision to follow a certain treatment plan is highly likely to be influenced by their beliefs about the medicine and their beliefs about the illness that the medication is intended to treat or prevent. The role of health beliefs in treatment adherence has been recognized as a priority for adherence research. A patient’s ability to make a sound decision in the management of his or her condition is impaired by the presence of depression. Hence, during medical management of COPD, the occurrence and diagnosis of depression are also looked into and possibly treated to optimize medication adherence and management of COPD symptoms.

Treatment

• Tricyclic Antidepressants (TCAs) - The patients that deal with depression and COPD are given tricyclic antidepressants (TCAs) as their medication. It works on improving their mood but has a very little effect on COPD.

• Cognitive Behavioral Therapy (CBT) - This treatment method is also effective in improving the physical and mental well-being of a person who has COPD. Feeling tired, lack of energy, loss of weight, and having a disturbed sleeping pattern can be common in patients with COPD.

• Corticosteroids - The relationship between corticosteroids and a person's mood is complex and can lead to various outcomes. Patients who are on corticosteroids have a development on their mood. However, a lower dosage of steroids can cause joint pains and tiredness. 

• Therapy for Depression and COPD - A person with COPD needs to take medications as well as undergo therapy with the supervision of a mental health specialist. One learns how to cope and adapt with COPD. Joining a group discussion can help boost one's self-confidence. It is very important to reach out for help to treat depression.

How long does it take to treat COPD and depression?

There is no time guaranteed to completely cure COPD. A person who is diagnosed at an early stage and exercises regularly can live a full life. One needs to understand what triggers COPD to take the necessary course of action along with medications.

If you are into the habit of smoking, then try to quit it. Studies have shown that quitting cigarette smoking slows down the progression of COPD. Exposure to secondhand fumes from factories, inhalation of chemicals, dust, and other pollutants for a long period of time are some of the major COPD risk factors. Genetics also plays an important role in developing COPD. Hence, it is necessary to take preventive steps.