Can antidepressants help manage breathlessness?
21st July 2025
Breathlessness (trouble breathing) is a common and upsetting symptom for people receiving palliative or supportive care. When treatments aimed at the disease itself stop working, there are few approved medicines to help. Some doctors have tried using antidepressants, even in patients who aren’t depressed, because these medicines affect the brain areas and chemicals (like serotonin) that may influence how we feel breathlessness. This review looks at the latest research to see if antidepressants are safe and effective for treating breathlessness. The review was carried out by researchers based at the Cicely Saunders Institute, King’s College London, MD Anderson Cancer Centre in the US and Nicolaus Copernicus University, Poland.
Breathlessness is affected by three main areas: how the lungs and brain interact, how the body functions and behaves, and a person’s mental, emotional, and spiritual state. These factors apply to many diseases, so they’re important in palliative care. While small early studies showed some promise, two recent large studies on the antidepressants mirtazapine and sertraline found no improvement in breathlessness. In fact, people taking mirtazapine had more side effects than those taking a placebo (a fake pill). Earlier research was based on small trials that had design problems. One older study found sertraline helped depression in people with stable COPD, but recent concerns show that antidepressants might cause more health problems in people with breathing diseases. This means it’s important to spot people at risk early and take a well-rounded approach to treatment.
The researchers concluded that there’s not enough strong evidence to support using antidepressants to treat breathlessness in people with breathing diseases. Safer, non-drug treatments should be tried first because they have fewer risks and proven benefits. Using antidepressants for this purpose should be done carefully and ideally within a clinical trial. Because breathlessness is complex, future research should focus on finding and testing new treatments through well-designed studies that also track side effects, health service use, and effects on caregivers.
Higginson IJ, Bajwah S, Krajnik M, Jolley CJ, Hui D. Recent advances in understanding the role of antidepressants to manage breathlessness in supportive and palliative care. Curr Opin Support Palliat Care. 2025 Jun 1;19(2):83-94. doi: 10.1097/SPC.0000000000000761. Epub 2025 Apr 21. PMID: 40265531; PMCID: PMC12084019.