Prednisone-dependent asthma patients "deserve"
screening for depression and anxiety, the authors say, both to
alleviate their suffering and possibly improve their physical health
through mental health treatment.
"There's a well-established connection with asthma, as well as
chronic illness in general, and higher reports of depression than
the general population," Dr. Rebecca Hashim told Reuters Health.
Hashim, an attending psychologist at Children's Hospital at
Montefiore Medical Center in New York, was not involved in the
Prednisone is a steroid anti-inflammatory medication used to treat
asthma attacks, often among people with severe symptoms.
Previous research has linked steroid use to depression and other
mood problems. And links in both directions have been found between
depression and the severity of asthma symptoms.
To examine depression risk among asthma patients, Dr. Marijke
Amelink, from the department of Respiratory Medicine at the Academic
Medical Centre at the University of Amsterdam, and Dr. Simone
Hashimoto, of the Institute of Psychiatry at Leiden University in
Leiden, recruited 187 patients.
Among the patients, 67 had severe prednisone-dependent asthma and 47
had severe non-prednisone dependent asthma. Another 73 patients had
mild to moderate asthma.
People in the three groups were similar, although
prednisone-dependent patients tended to be older, with greater
limitations in their ability to breathe.
All patients answered questions about depression and anxiety, as
well as questions designed to detect personality traits that could
contribute to their risk of mood issues.
The researchers found that patients with severe prednisone-dependent
asthma were 3.4 times more likely to be depressed than
non-prednisone dependent patients with severe asthma, and 3.5 times
more likely to be depressed than patients who had mild to moderate
The prednisone-dependent patients were also 2.5 times more likely to
have anxiety compared to patients with mild to moderate symptoms,
but there was no significant difference when compared to those with
severe non-prednisone dependent asthma.
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The Dutch researchers didn't find any significant differences in
personality traits among the participants.
In their report in the journal Respiratory Medicine, the authors
point out that non-prednisone-dependent asthma patients had
depression and anxiety scores that were similar to those of the
general public, while the prednisone-dependent patients had scores
similar to patients with other serious medical conditions.
Hashim said the increased risk of depression might be due to the
stress of the treatment, rather than severity of illness. This would
be similar to other chronic illnesses, such as diabetes, that
require complex daily treatment regimens.
"It's not really disease severity so much, but I think what it does
speak to is the level of maintenance required," she said, "It
reminds you of your illness all the time."
Having long-term untreated depression or anxiety can potentially
lead to further illness, especially if it affects patients' ability
to take care of their health.
"The more depressed you are, the less likely you're going to be to
be able to take care of these responsibilities," she added.
Hashim said it's important for doctors to be screening for
depression, adding that caregivers and loved ones can go along on
the office visits to express their concerns to their doctors.
Respiratory Medicine, online Jan. 6, 2014.
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