By Batya Swift Yasgur

adness. "The blues." Lack of interest in friends or once-enjoyable activities. Feeling "blah." Most people experience these feelings from time to time, but then they persist more than a few weeks they may be signs of depression. Although all types of people suffer from depression, it is especially common in people with chronic obstructive pulmonary disease (COPD). "Depression affects almost half of people with COPD," says Rachel Norwood, MD, Instructor of Psychosocial Medicine at the National Jewish Medical and Research Center in Denver.

It is normal to experience feelings of sadness when facing a chronic illness and it is certainly painful to receive the diagnosis and accept the permanence of the condition. Just contemplating the day-to-day difficulties posed by the illness may seem overwhelming. However, if feelings of sadness or hopelessness settle in rather than dissipate with time, they are symptoms of depression. This type of depression, triggered by bad news or life challenges, is called a reactive depression because it is a reaction to circumstances.

However, the depression that affects people with COPD goes beyond the reactive depression that affects individuals with other chronic conditions. "One of the most interesting aspects of COPD depression is that it is more prevalent in people with COPD than in people with other chronic conditions, such as heart disease, HIV, and even cancer. “This suggests that there are organic or chemical-not just reactive-components,” Dr. Norwood explains.

WHY THE HIGHER RATES OF DEPRESSION IN COPD?

There are many reasons why people with COPD are more prone to depression, Dr. Norwood notes. "We are just beginning to understand them." The first is a genetic predisposition, which can be present as early as childhood. "The tendency to become depressed may begin during the teen years and may increase the risk of nicotine addiction," she explains. Research has shown that adolescents who are depressed are more likely to become addicted to cigarettes. "Many kids experiment with cigarettes but those who are not depressed are more likely to discontinue use compared with those who are depressed."

Thus smokers have a higher rate of depression than individuals in the general population; and smoking is also a leading risk factor for the development of COPD. "It is a double-barreled situation—depressed people are more likely to turn to cigarettes and smoking causes COPD," Dr. Norwood says. "Additionally, cigarette smoking creates a biochemical environment in me body that contributes to depression."

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