In their discussion, the authors rightly suggest that patients responding to antidepressant medications might change their end-of-life preferences as their moods improved. In view of this suggestion, it would also be important if the authors could reanalyze their data examining whether the preference rates for CPR among the depressed COPD patients might change with adjustment for antidepressant medication use in the multivariate analyses. Adjustment for antidepressant medication use might lend further support to the need for end-of-life preferences reassessment after an adequate trial of antidepressants. In addition to improving mood, antidepressant medications may have additional benefits for other common COPD comorbidities: reduction of tobacco craving, palliation of subjective dyspnea, improvement of appetite with weight loss reversal, and lowering of anxiety symptoms.2–4 The nihilistic attitude fostered by depressive symptoms and other common psychological comorbidities in COPD patients may dissipate with antidepressant use, possibly leading to a more informed decision regarding end-of-life-care preferences. Given the high prevalence of depression in the COPD population,5 screening for (and early treatment of) depression in these patients should be part of routine care, as treatment might improve their overall quality and quantity of life. A large, controlled trial of the impact of antidepressants on overall well-being and survival of COPD patients with depression is long overdue.