emphysema lungs
Advanced centrilobular emphysema with total involvement of secondary lung lobules on the left and centrilobular localization still apparent on the right. Source: Wikipedia Commons

Trying to Breathe Easier May Backfire

Prescribing antidepressants to elderly respiratory patients can increase risk of death. What other choices do doctors have?


A Canadian study has found that antidepressants can increase the risk of death by 20% for elderly Chronic Obstructive Pulmonary Disease (COPD) patients.

The study, conducted by St. Michael’s Hospital in Toronto, additionally found a 15% higher chance of hospitalization because of related symptoms.

Researchers focused on COPD sufferers with a prescription for serotonergic antidepressants (SSRIs and SNRIs), the most common class of this medicine. Participants using this medication were linked to higher rates of emergency room visits and mortality from respiratory difficulties, along with the overall higher mortality rate.

“We were not surprised by these findings, as there are biological reasons why antidepressants could lead to respiratory issues,” says lead author Nicholas Vozoris.

“These drugs can cause sleepiness, vomiting and can negatively impact immune system cells. This increases the likelihood of infections, breathing issues, and other respiratory adverse events, especially in patients with COPD.”

COPD is an umbrella term for an array of progressive respiratory diseases, such as emphysema and bronchitis, which affect over 10% of people over 40 worldwide. Breathlessness is the hallmark of the condition and patients often struggle mentally due to their physical burden.

Hence, many are prescribed antidepressants to cope – Vozoris noted that upwards of 70% of patients struggle with low moods and anxiety. Similarly, a 2010 study found that anxiety is widespread amongst the COPD population.

Alternative forms of care may be necessary

Vozoris and his colleagues used databases from the Institute of Clinical Evaluated Sciences to study over 28,000 elderly (66 years of age or older) COPD patients also using SSRIs. This group was cross-compared with another group of COPD sufferers of approximately the same number who were not prescribed the medication.

Although a strong correlation between the medication and an increased mortality rate with elderly COPD sufferers was found, the exact mechanism remains a mystery.

“The study results should not cause alarm among those who use these medications, but rather increase caution among patients and physicians,” says Vozoris.

Due to the heightened risk with SSRIs, Vozoris and his colleagues believe physicians should consider drug-free alternatives. They suggest psychotherapy or pulmonary rehabilitation, which involves counselling and respiratory specialists who help patients recuperate as much functionality in their lungs as possible, improving their quality of life and relieving some of the burden of COPD.

“I hope our study encourages increased awareness when prescribing these medications and monitoring for adverse side effects,” says Vozoris.

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Barry is a journalist, editor, and marketer for several media outlets including HeadStuff, The Media Editor, and Buttonmasher Magazine. He earned his Master of the Arts in Journalism from Dublin City University in 2017 and moved to Toronto to pursue a career in the media. Barry is passionate about communicating and debating culture, science, and politics and their collective global impact.