People with severe asthma who rely on prednisone are more than three times more likely to be depressed than those with severe cases who don’t use prednisone and those with mild to moderate asthma, according to a new study from The Netherlands.

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 study.

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 asthma.

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.

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.

SOURCE: Respiratory Medicine, online January 6, 2014

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Anxiety, depression and personality traits in severe, prednisone-dependent asthma

Anxiety and depression are prevalent in patients with asthma, and associated with more exacerbations and increased health care utilization. Since psychiatric intervention might improve asthma control, we examined whether patients with severe, prednisone-dependent asthma are at higher risk of these disorders than patients with severe non-prednisone dependent asthma or mild-moderate asthma, and whether they exhibit different personality traits.
Methods

Sixty-seven adults with severe prednisone-dependent asthma, 47 with severe non-prednisone dependent and 73 patients with mild-moderate asthma completed the HADS depression and anxiety subscale and the NEO-FFI for personality traits. In addition, asthma duration, body mass index and FEV1 were measured.
Results

The prevalence of clinically significant depressive symptoms (9% vs. 0 vs. 0%; p = 0.009) and anxiety symptoms (19% vs. 6.4 vs. 5.5%; p = 0.01), was higher in patients with severe, prednisone-dependent asthma than in patients with severe non-prednisone dependent or mild-moderate asthma. Patients with prednisone-dependent asthma were respectively 3.4 (95%CI: 1.0–10.8 p = 0.04) and 3.5 (95%CI: 1.3–9.6 p = 0.01) times more likely to have significant depression symptoms and 1.6 (95%CI: 0.7–3.7, p = 0.2) and 2.5 (95%CI: 01.1–5.5, p = 0.02) times more likely to have symptoms of anxiety than patients with severe non-prednisone dependent or mild-moderate asthma. There were no differences found in personality traits between the 3 groups.
Conclusion

Patients with severe, prednisone-dependent asthma have more often psychological distress as compared to patients with severe non-prednisone dependent or mild-moderate asthma.

Marijke Amelink, Simone Hashimoto, Philip Spinhoven, Henk R. Pasma, Peter J. Sterk, Elisabeth H. Bel, Anneke ten Brinke
Respiratory Medicine - 06 January 2014 (10.1016/j.rmed.2013.12.012)


Institute of Psychology, Leiden University, Leiden, The Netherlands
Department of Psychiatry, Leiden University Medical Centre, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands