Breathlessness in Depression

¹ Consultant Psychiatrist, East Birmingham Group, Hollymoor Hospital, Birmingham 31

Sixty-six patients with breathlessness as a prominent symptom were investigated. The experience of their breathlessness was studied in detail. Thirty-three had advanced obstructive airway disease with an F.E.V._.1 of below 1 litre. A second group of 33 had a depressive illness; in addition most of this group had chronic bronchitis and some a mild degree of airways obstruction.

There were distinct differences in the way in which the two groups of patients experienced their breathlessness. In those with depression breathlessness occurred at rest and the main difficulty was on inspiration. They experienced a persistent `heaviness' on the sternum, and their breathlessness fluctuated rapidly and was frequently associated with hyperventilation and sighing respiration. Depressive delusions of imminent death were present, most commonly related to intractable fears of lung cancer and heart failure. The somatic symptoms disappeared with psychiatric treatment and resolution of the depressive illness.

Such symptoms were not experienced by the group with advanced obstructive airway disease. Their breathlessness was exertional, of insidious onset and with the main difficulty on expiration. Recurrent hyperventilation attacks occurred in only one of the thirty-three. Their breathless ness was relieved by rest, expectoration and stopping smoking.