Treatment of Depressed Chronic Obstructive Pulmonary Disease Patients

Treatment Effectiveness in Depressed Patients With Chronic Obstructive Pulmonary Disease

Approximately 20% of patients with chronic obstructive pulmonary disease (COPD) have major depression, a condition that contributes to suffering but also to poor treatment adherence leading to increased disability and morbidity. This study investigates the effectiveness of a care management intervention aimed at facilitating adherence to a treatment algorithm based on the Agency for Health Care Policy and Research (AHCPR) guidelines. The investigators hypothesize that this intervention, in comparison to usual care, will increase the prescription of adequate antidepressant treatment by physicians, enhance treatment adherence by patients, and reduce depressive symptoms, suicide ideation, and disability at a 28-week follow-up period.

Inclusion Criteria:

• Chronic obstructive pulmonary disease by American Thoracic Society criteria
• Major depression by DSM-IV criteria
• 17-item Hamilton score >14
• English speaking

Exclusion Criteria:

• Inability to give informed consent
• MiniMental score <24
• Aphasia
• Nursing home placement after discharge