You are not alone. Depression is a common problem for patients with pulmonary fibrosis. Common symptoms include feeling blue, loss of interest in activities that you usually enjoy, increased or decreased sleep, irritability, change in appetite, frequent crying, avoiding social situations and thoughts of hurting yourself. The symptoms of depression may be mild, moderate or severe.
Most IPF patients struggle with declining physical capabilities as their illness progresses. They are frustrated by their inability to accomplish the tasks they formerly were able to do. Changes in interpersonal relationships are inevitable and this can be an additional source of frustration. It is normal to have periods of frustration and anger about your illness. When you are stuck feeling angry and unhappy most of the time, then your emotional response crosses from a normal healthy response to a maladaptive and unhealthy response. At this time you need to seek help from your healthcare team.
What can IPF patients do about feeling depressed?
First, it is vital to understand that you are not alone. Feeling depressed is not a sign of weakness. It does not mean that you are crazy or defective. In my practice, depression is the rule not the exception among patients with advanced lung disease. I ask my patients about their mood, outlook, activities that they enjoy and their important relationships. Talk therapy is effective in mild depression. Simply acknowledging depression and openly talking about your feelings of sadness and frustration can be an effective first step.
Non-medication strategies to deal with depression
• Talk therapy with a counselor, therapist or psychiatrist, or even a close friend or family member. Avoid withdrawing from your friends and family. Allow people to be near you.
• Exercise can be very helpful. Even just going for a slow walk can help release endorphins (chemicals in your brain that help you feel better).
• Join a support group. Connecting with other patients with pulmonary fibrosis may help you feel less isolated.
Medications for Depression
Medications are important when depression is more than mild. Agreeing to take an antidepressant does not mean that you are a failure. Nor does it mean that you will need one forever. Antidepressants are not addictive. There are many different types of antidepressants. The most commonly prescribed are in the family of SSRI (selective serotonin reuptake inhibitor). This family of medicines works by increasing serotonin levels in your brain. They are very safe and generally well tolerated. All medications have side effects. SSRI side effects are usually mild but can include some stomach upset or very transient worsening of anxiety in the first week or two. Some patients may notice delayed orgasm (don’t worry this is not permanent). I generally start at the lowest dose of medication. The dose can be gradually increased if the starting dose is not effective. The medications don’t work immediately. Many take 2-6 weeks to take full effect. Your friends and family may notice improvement in your mood a few weeks before you do.
How long should depression be treated?
I generally treat depression in my IPF patients for at least six months and usually a year or longer. After that time period, if the symptoms are dramatically better it may be appropriate to gradually taper off the medication.
When is depression an emergency?
Depression can be an emergency if you are having thoughts of hurting yourself or you are considering stopping your medications. If you are having these thoughts you should immediately reach out to your treatment team and be seen. If you can’t reach your treatment team, then call your primary care doctor or even go to the emergency department.