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Cited by 59Chronic Obstructive Pulmonary Disease (COPD) ResearchTreatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Pharmacological interventions for the treatment of depression in chronic obstructive pulmonary disease

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Pollok, Justyna, van Agteren, Joep EM, Carson-Chahhoud, Kristin V·2018·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd012346.pub2PMC PMC6517114
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Abstract

BACKGROUND: Studies report that up to 80% of individuals with chronic obstructive pulmonary disease (COPD) may struggle with symptoms of depression. However, this major comorbidity in COPD is rarely managed effectively. A number of recent studies indicate that left untreated, COPD-related depression is associated with worse quality of life, worse compliance with COPD treatment plan, increased exacerbations, hospital admissions, and healthcare costs when compared to individuals with COPD without depression. Regrettably, COPD practice guidelines do not provide conclusive treatment recommendations for the use of antidepressants in patients with COPD, and base their guidelines on findings from trials in the general population. This may be problematic, as there is an elevated risk of respiratory issues associated with antidepressant treatment and COPD. Evaluating effectiveness and safety of pharmacological interventions specifically for patients with COPD and depression was therefore paramount. OBJECTIVES: To assess the effectiveness and safety of pharmacological interventions for the treatment of depression in patients with COPD. SEARCH METHODS: The last search was performed on 26 November 2018. We initially searched the following databases via the Specialised Trials Registers of the Cochrane Airways and Common Mental Disorders Groups (to June 2016): MEDLINE, Embase, PsycINFO, CINAHL, AMED, and the Cochrane Library trials register (CENTRAL). Searches from June 2016 to November 2018 were performed directly on Ovid MEDLINE, Embase, PsycINFO and the Cochrane Library (Issue 11, 2018). We searched ClinicalTrials.gov, the ISRCTN registry, and the World Health Organization International Clinical Trials Registry Platform to 26 November 2018. We searched the grey literature databases to identify studies not indexed in major databases and the reference lists of studies initially identified for full-text screening. SELECTION CRITERIA: All published and unpublished randomised controlled trials (RCTs) comparing the efficacy of pharmacological interventions with no intervention, placebo or co-intervention in adults with diagnosed COPD and depression were eligible for inclusion. DATA COLLECTION AND ANALYSIS: ), change in exercise tolerance, change in hospital utilisation (length of stay and readmission rates), and cost-effectiveness. For continuous outcomes, we calculated the pooled mean difference (MD) or standardised mean difference (SMD) with 95% confidence interval (CI) as appropriate. For dichotomous outcomes, we calculated the pooled odds ratio (OR) and corresponding 95% CI using a random-effects model. We assessed the quality of evidence using the GRADE framework. MAIN RESULTS: post-treatment (MD 0.01, 95% CI -0.03 to 0.05; 148 participants; 2 studies; P = 0.60; low-quality evidence). However, two trials reported improvement in exercise tolerance in the SSRI group versus the placebo group (MD 13.88, 95% CI 11.73 to 16.03; 148 participants; 2 studies; P < 0.001; very low-quality evidence).The trials included in this comparison did not report data related to the change in dyspnoea, hospital utilisation rates, or cost-effectiveness. AUTHORS' CONCLUSIONS: There is insufficient evidence to make definitive statements about the efficacy or safety of antidepressants for treating COPD-related depression. New RCTs are needed; with better methodological quality and more accurate reporting of the methods used. Moreover, longer-term follow-up data collection is needed, including outcomes such as adverse events, hospital utilisation and cost-effectiveness.

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Research works printed but not linked: 6

  1. NICE 2010 National Institute for Health and Clinical Excellence. CG90 Depression: The treatment and management of depression in adults: NICE guideline (updated edition). National Collaborating Centre for Mental Health. London, UK 2010.
  2. Ryan R, Hill S. How to GRADE the quality of the evidence. Cochrane Consumers and Communication Review Group December 2016.
  3. Sadock BJ, Sadock VA, Ruiz P. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. 9th Edition. Philadelphia, London: Wolters Kluwer Health/Lippincott
  4. Schatzberg AF, Rothschild AJ. Serotonin activity in psychotic (delusional) major depression. Journal of Clinical Psychiatry 1992;53:52-5.
  5. Schünemann HJ, Oxman AD, Vist GE, Higgins JP, Deeks JJ, Glasziou P, et al. on behalf of the Cochrane Applicability and Recommendations Methods Group. Chapter 12: Interpreting results and drawing conclusions. In: Higgins JPT, Churchill R, Chandler J, Cumpston MS, editor(s). Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017). Cochrane, 2017. Available from www.training.cochrane.org/handbook.
  6. Spitzer RL, Kroenke K, Williams JB, Patient Health Questionnaire Study Group. Validity and utility of a self-report version of PRIME-MD: the PHQ Primary Care Study. JAMA 1999;282:1737-44.

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Authors
Pollok, J., van Agteren, J. E., & Carson-Chahhoud, K. V.
Affiliations
  • The University of Adelaide (AU)
  • Flinders University; College of Medicine and Public Health; Adelaide Australia
  • The University of South Australia; School of Health Sciences; City East Campus, Frome Road Adelaide Australia 5001
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2018-12-19
Volume
2018
Issue
12
Pages
CD012346-CD012346
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd012346.pub2
PMC
PMC6517114
OpenAlex
W2519961995
Cited by
59
References
127
Citations by year
2026: 3 · 2025: 6 · 2024: 12 · 2023: 7 · 2022: 10 · 2021: 8 · 2020: 9 · 2019: 1 · 2018: 1 · 2017: 1 · 2013: 1
FWCI
0.85
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
chronic obstructive pulmonary disease, depression, antidepressants, pharmacotherapy, comorbidities, treatment effectiveness, treatment safety, hospital readmission, length of hospital stay, cost-effectiveness, exercise tolerance, quality of life, exacerbations, guideline recommendations
MeSH terms
Antidepressive Agents, Tricyclic, Depression, Dizziness, Dyspnea, Forced Expiratory Volume, Humans, Nausea, Nortriptyline, Placebos, Quality of Life, Randomized Controlled Trials as Topic, Exercise Tolerance, Selective Serotonin Reuptake Inhibitors, Paroxetine, Sertraline, Pulmonary Disease, Chronic Obstructive

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