Are There Effective Medications for Treating Depression in COPD?
No formal guideline exists. Choice of antidepressant drugs should target other comorbidities that are common in COPD.10,22-24 Such comorbidities include tobacco use, poor appetite, weight loss, anxiety disorders (eg, panic and generalized anxiety disorders), and sleep disturbances. Bupropion, for example, targets depression and reduces craving for tobacco. The downside of bupropion is its tendency to promote weight loss in some patients. Bupropion is contraindicated in persons with seizure disorders and bulimia nervosa. Another antidepressant that palliates multiple symptoms is mirtazapine, a noradrenergic and selective serotonergic antagonist.23 Because of its central antagonism at serotonin (5-HT) type 2 and 3 postsynaptic receptors, mirtazapine reduces anxiety, increases appetite, and improves sleep architecture. Selective serotonin reuptake inhibitors (SSRIs) as a group are good choices because of their better safety profile over the tricyclic antidepressant agents. Selective serot
