Anxiety and depression in advanced lung disease

Anxiety, panic, and depression commonly complicate chronic airflow obstruction, and probably other forms of advanced lung disease as well. Despite the recent development of many new therapeutic options, these conditions remain under-recognized and under-treated in this patient population. Under-diagnosis may result in part from the challenge of distinguishing between the somatic manifestations of psychiatric disease and the physical symptoms of severe respiratory dysfunction. Treatment relies on judicious pharmacotherapy and appropriate psychologic support. Serotonin selective reuptake inhibitors are particularly useful in the treatment of depression and panic, and may be helpful in controlling other forms of anxiety, as well. Cognitive behavioral therapy is an important adjunct in the management of anxiety. Electroconvulsive therapy should be considered for selected lung disease patients with refractory depression.