Once dismissed as weakness of human will, chronic depression is increasingly recognized as a legitimate medical problem that is critical to treat. The condition not only affects quality of life, but may also cause additional dire effects on health, specifically in people with cystic fibrosis (CF).
German researchers have found that depression actually makes lung function worse in people with CF. They published their findings in the December 16th issue of BMC Pulmonary Medicine.
Depression is well-known to worsen stress responses, suppressing the immune system and increasing the problems associated with virtually any medical condition, including CF. A recent study reported that nine percent of adolescent and adult patients with CF have symptoms of depression, similar to the prevalence of depression in the general population. Until now it has not been clear whether depression makes lung function worse in CF.
In research led by Astrid Fidika, of the Department of Child and Adolescent Psychiatry/Psychotherapy, University Ulm Medical Centre, Germany, 473 patients with CF, age 12-53 years, filled out a survey called the Hospital Anxiety and Depression Scale (HADS). The scientists also assessed lung function at the start of the study as well as two years later. They measured lung function using spirometry, which assesses the amount and speed of air inhaled and exhaled. According to the researchers, “This is the first study to examine the impact of depression on change in lung function.”
As might be expected, lung function was affected more in people with depression over the two-year period. Interestingly, the largest decline in lung function occurred in the people with depression who actually had good lung function at the start of the study. Patients without symptoms of depression at the beginning of the study with poor lung function experienced a small improvement in lung function two years later.
In their report, the scientists stated: “The results show that clinically relevant symptoms of depression may increase the loss of lung function and that severely ill patients without depression are able to improve their lung function against the progressive trend of CF. Principal author, Lutz Goldbeck further noted that “The results of our study emphasize the need to address mental health issues in patients with cystic fibrosis. Psychological health and physical health are closely associated. Therefore recent international mental health guidelines for CF recommend annual screening for depression and anxiety and appropriate psychological or psychiatric interventions.”
This study indicates the importance of identifying and treating depression in people with CF. No clinician has yet developed specific treatments tailored to people with CF and depression, however. The study authors noted that because no tailored treatments for people with CF and depression exist, current psychotherapeutic methods for addressing depression are needed.
They also cautioned, however, that treatment with medication warrants more careful evaluation, noting that “in psychopharmacological treatment, possible reciprocal effects between CF medication and medication for depression have to be considered.” Before starting an anti-depressant, healthcare providers and patients should evaluate the possible interactions of anti-depressants with other medications that the person with CF is taking.
Depression may have the same biological characteristics as a prolonged stress response, characterized by the release of stress hormones. While these hormones — such as cortisol — can be useful for short-term responses to stress, over time cortisol can suppress the immune system and damage tissues. This can be devastating for people with depression and another medical condition like CF, as the current study shows. Identifying depression and treating it in people with Cystic Fibrosis might greatly improve outcomes for this difficult condition.
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