Strategies to improve anxiety and depression in patients with COPD: a mental health perspective.

Chronic obstructive pulmonary disease (COPD) is a pulmonary disease characterized by progressive and potentially reversible symptoms.  In COPD, anxiety and depression are surprisingly common.  This article aimed to comment on the lack of literature of psychological disorders associated with COPD.  First, this study stressed that patients prefer to be treated by non-pharmacological means instead of drug therapy.  Individual and group therapy are useful in treating patients with COPD.  Most antidepressants work the same on depression but have different side effects based on drug class.  This article also stressed that one-third of patients suffering from anxiety and depression due to COPD are untreated.  It also states that one-third of patients with COPD have related anxiety and depression.  Despite all the research conducted by this article it was not able to provide a concise treatment plan but it did specify that mental illness is widely under-diagnosed and under-treated.

This article was interesting to me becasue it was a review article about a topic that I had heard about but had very little knowledge on the matter beforehand.  I heard of COPD but did not know there was such a high correlation between between depression and anxiety and COPD.  I was also curious to see that drug therapy was not the primary source of treatment for this disease state and it was instead preferred to treat using group and individual therapy.  Considering we rarely discuss that form of treatment it was interesting to see that as the principle treatment and learn more about it.

Tselebis A, Pachi A, Ilias I, et al. Strategies to improve anxiety and depression in patients with COPD: a mental health perspective. Neuropsychiatric Disease and Treatment. 2016;12:297-328 

Cannabidiol induces rapid-acting antidepressant-like effects and enhances cortical serotonin/glutamate neurotransmission

In a novel study by Linge and colleagues, cannabidiol (CBD) was shown to exhibit strong anxiolytic and antidepressant effects in mice. The study also elucidated CBD’s mechanism of action on serotonin receptors in the brain. Their findings indicate that CBD could represent a novel fast-acting antidepressant drug.

CBD is the main non-psychotomimetic component of marijuana. This means that behind THC, the compound responsible for many of the mind-altering affects we collectively refer to as a “high,” CBD produces the majority of it’s therapeutic benefit without inducing highness. Utilizing the olfactory bulbectomy (OBX) mouse model of depression, researchers studied the behavioral efficacy of CBD via the enhancement of serotonergic and glutamatergic transmission through the modulation of 5-HT 1A receptors. Classical antidepressants act through similar serotonergic attenuation whereas the effects of fast-acting antidepressants seem to be mediated mainly by glutamatergic signalling.

The results of this study shows that CBD exerts rapid antidepressant-like effects as evidenced by the reversal of OBX-induced hyperactivity immediately after the first injection. Additionally, its efficacy is maintained and improved with the repeated administration, as anhedonia (inability to feel pleasure) was completely relieved after one week of treatment with a dose of 50 mg/kg. The findings also revealed a crucial role of 5-HT 1A and CB1 receptors in the behavioral and anxiolytic effects of CBD. As anxiety is a complex syndrome affected by different brain processes, the two receptors could be implicated in the anxiety outcome at different levels.

In summary, the fast onset of antidepressant action of CBD and the simultaneous anxiolytic effects, combined with the broad range for therapeutic dosage and the lack of psychotomimetic effects shows a strong therapeutic advantage for its use in clinical practice compared to other antidepressant alternatives.

Linge R, Jiménez-Sánchez L, Campa L, et al. Cannabidiol induces rapid-acting antidepressant-like effects and enhances cortical 5-HT/glutamate neurotransmission: role of 5-HT1A receptors. Neuopharmacology 2016;103:16-26