Chronic obstructive pulmonary disease (COPD) affects between 15% and 25% of older people,1 2 who suffer also frequently from mental illnesses.3–5 As such, patients with COPD may require pharmacological treatments to manage psychiatric disorders. Guidelines for the treatment of depression in geriatric population recommend the use antidepressants (combined with interpersonal psychotherapy),6 and specifically second-generation ones, due to the reduced risk of side effects and the better tolerability in case of overdose. Second-generation antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) and norepinephrine and dopamine reuptake inhibitors. Pharmacotherapy is recommended not only for primary depression but also for the treatment of depression associated with other medical conditions, including neoplasms, heart and pulmonary diseases, arthritis and Parkinson disease.7

Like other psychotropic drugs, however, also antidepressants may occasionally induce negative respiratory outcomes especially in older people. Several potential mechanisms for antidepressant drugs-induced respiratory harm have been proposed, indicating that such drugs should be cautiously used in patients with COPD.

First, among patients with COPD, safety data from randomised controlled trials of SSRIs and SNRIs showed that around 10%–20% of patients treated with these drugs experience …

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