People with chronic obstructive pulmonary disease (COPD) have a greater risk for depression, stress, and anxiety. Being stressed or depressed can make COPD symptoms worse and make it harder to care for yourself.

Chronic obstructive pulmonary disease - emotions; Stress - COPD; Depression - COPD

When you have COPD, caring for your emotional health is just as important as taking care of your physical health. Learning how to deal with stress and anxiety and seeking care for depression can help you manage COPD and feel better in general.

Having COPD can affect your mood and emotions for several reasons:

• You cannot do all the things you used to do.
• You may need to do things much slower than you used to.
• You may often feel tired.
• You may have a hard time sleeping.
• You may feel ashamed or blame yourself for having COPD.
• You may be more isolated from others because it is harder to get out to do things.
• Breathing problems can be stressful and scary.

All of these factors can make you feel stressed, anxious, or depressed.

Having COPD can change how you feel about yourself. And how you feel about yourself can affect COPD symptoms and how well you care for yourself.

People with COPD who are depressed may have more COPD flare-ups and may have to go to the hospital more often. Depression saps your energy and motivation. When you are depressed, you may be less likely to:

• Eat well.
• Exercise.
• Take your medicines as directed.
• Follow your treatment plan.
• Get enough rest or sleep. Or, you may get too much sleep or be too inactive.

Stress is a known COPD trigger. When you feel stressed and anxious, you may breathe faster, which can make you feel short of breath. When it is harder to breathe, you feel more anxious, and the cycle continues, leading you to feel even worse.

There are things you can and should do to protect your emotional health. While you cannot get rid of all the stress in your life, you can learn how to manage it. These suggestions may help you relieve stress and stay positive.

• Identify the people, places, and situations that cause stress. Knowing what causes you stress can help you avoid or manage it.
• Try to avoid things that make you anxious. For example, do not spend time with people who stress you out. Instead, seek out people who nurture and support you. Go shopping during quieter times when there's less traffic and fewer people around.
• Practice relaxation exercises. Deep breathing, visualization, letting go of negative thoughts, and muscle relaxation exercises are all simple ways to release tension and reduce stress.
• Do not take on too much. Take care of yourself by letting go and learning to say no. For example, perhaps you typically host 25 people for Thanksgiving dinner. Cut it back to 8. Or better yet, ask someone else to host. If you work, talk with your boss about ways to manage your workload so you do not feel overwhelmed.
• Stay involved. Do not isolate yourself. Make time every week to spend time with friends or attend social events.
• Practice positive daily health habits. Get up and get dressed every morning. Move your body every day. Exercise is one of the best stress busters and mood boosters around. Eat a healthy diet and get enough sleep every night.
• Talk it out. Share your feelings with trusted family members or friends. Or talk with a clergy member. Do not keep things bottled up inside.
• Follow your treatment plan. When your COPD is well-managed, you will have more energy for the things you enjoy.
• Do not delay. Get help for depression.

Feeling angry, upset, sad, or anxious at times is understandable. Having COPD changes your life, and it can be hard to accept a new way of living. However, depression is more than occasional sadness or frustration. Symptoms of depression include:

• Low mood most of the time
• Frequent irritability
• Not enjoying your usual activities
• Trouble sleeping, or sleeping too much
• A big change in appetite, often with weight gain or loss
• Increased tiredness and lack of energy
• Feelings of worthlessness, self-hate, and guilt
• Trouble concentrating
• Feeling hopeless or helpless
• Repeated thoughts of death or suicide

If you have symptoms of depression that last for 2 weeks or more, contact your health care provider. You do not have to live with these feelings. Treatment can help you feel better.

Contact your doctor if:

• You hear voices or other sounds that are not there.
• You cry often for no apparent reason.
• Your depression has affected your work, school, or family life for longer than 2 weeks.
• You have 3 or more symptoms of depression (listed above).
• You think one of your current medicines may be making you feel depressed. Do not change or stop taking any medicines without checking with your doctor.
• You think you should cut back on drinking or drug use, or a family member or friend has asked you to cut back.
• You feel guilty about the amount of alcohol you drink, or you drink alcohol first thing in the morning.

You should also call your doctor if your COPD symptoms get worse, despite following your treatment plan.

If you or someone you know is thinking about suicide, call or text 988 or chat 988lifeline.org. You can also call 1-800-273-8255 (1-800-273-TALK). The 988 Suicide and Crisis Lifeline provides free and confidential support 24/7, anytime day or night.

You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.

If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.

Global Initiative for Chronic Obstructive Lung Disease (GOLD) website. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2023 report. goldcopd.org/2023-gold-report-2/. Accessed October 26, 2023.

Han M, Lazarus SC. COPD: Diagnosis and management. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 64.