A feasibility study of antidepressant drug therapy in depressed elderly patients with chronic obstructive pulmonary disease

Objectives To examine the acceptability of fluoxetine in elderly depressed patients: with chronic obstructive pulmonary disease (COPD). Setting A university teaching hospital. Method Single-blinded (open) study. One hundred and thirty-seven outpatient s (69 male) with symptomatic irreversible, moderate to severe COPD were rec ruited. Major depression was diagnosed using the Geriatric Mental State Sch edule. Quality of life was assessed by the Breathing Problem?; Questionnair e, physical disability by the Manchester Respiratory Activities of Daily Li ving Questionnaire and severity of depression using the Montgomery Asberg D epression Rating Scale. Exclusion criteria were: use of oral steroids withi n 6 weeks, acute or chronic confusion, known cancer and known psychosis. Results Fifty-seven patients (42%) (25 males) with a mean age of 72 years ( range 60-89 years) were depressed. Fourteen (six male) agreed to undergo th erapy with fluoxetine 20 mg/day for 6 months, while 36 (72%) refused antide pressant drug therapy. Only seven subjects completed the trial; of these, f our (57%) responded to fluoxetine therapy. Five subjects withdrew because o f side-effects. Twenty-two of those who refused treatment (61%) agreed to b e interviewed, and of these 19 (86%) were still depressed. Conclusion Patient acceptance of fluoxetine was poor. The reasons for refus ing treatment varied but were largely due to misapprehension by the patient . Untreated depression became chronic. Offering antidepressants to COPD pat ients with depression is not an effective strategy. Why this might be so is discussed. Copyright (C) 2001 John Wiley & Sons, Ltd.