Question: I am treating a patient with IPF who is showing signs of depression. As a pulmonologist, I am reticent to treat this comorbidity but I believe she would benefit from therapy. Who would be the best point person to manage her psychiatric issues?

Answer: Idiopathic Pulmonary Fibrosis, a progressive illness leading to respiratory insufficiency, is well known to affect patient's quality of life in the physical as well as emotional domains.

 

Although limited, studies have demonstrated significant negative feelings or depressive symptoms in about 20-25% of patients with IPF. With progressive respiratory insufficiency, patients may develop fatigue, sleep disturbances, muscle weakness, and decreased appetite. It is important to distinguish these symptoms from true depressive affect or despondency that may overcome our patients. Several steps can be taken that may help your patient:

  • Sleep studies and interventions for abnormal patterns (obstructive sleep apnea, restless leg syndrome or fragmented sleep with associated hypoxemia) may prove salutary to the patient1
  • Pulmonary rehabilitation and physical therapy may lead to improvement in emotional and physical well being (improved dyspnea and 6MWT)2
  • Support groups can reduce feelings of isolation and may provide useful coping mechanisms

Continued interest in the emotional state of our patients and openness to discuss their concerns and worries will offer welcome support. When appropriate, QOL questionnaires can help assess the development of symptoms and permit early intervention.3

However, certain patients require psychotherapy and/or psychiatric medication. One tool that has been used to screen for depression is a simple 2-part question4:

    During the past month:
  1. Have you often been bothered by feeling down, depressed, or hopeless?
  2. Have you often been bothered by having little interest or pleasure in doing things?

If you suspect that your patient suffers from affective disorder, you should refer her for expert evaluation. It is important to communicate with the therapist and discuss the patient's respiratory state, the associated limitations, and the dismal prognosis of IPF. Antidepressant medications may have sleep or respiratory side effects which are both of concern in patients with IPF.

  1. Krishnan V, McCormack MC, Mathai SC, et al. Sleep quality and health-related quality of life in idiopathic pulmonary fibrosis. Chest. 2008;134;693-698.
  2. Nishiyama O, Kondoh Y, Kimura T, et al. Effects of pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis. Respirology. 2008;13:394-399.
  3. De Vries J, Kessels BL, Drent M. Quality of life of idiopathic pulmonary fibrosis patients. Eur Respir J. 2001;17:954-961.
  4. Ebell MH. Routine screening for depression, alcohol problems, and domestic violence. Am Fam Physician. 2004;69:2421-2422.