Is successful treatment of depression in dialysis patients an achievable goal?

Abstract

Depression is undisputedly common among individuals with End‐Stage Kidney Failure and associated with adverse outcomes. It is well recognized that effective treatments for depression are needed within routine dialysis care. But, are we any closer to successfully treating depression in dialysis patients? We consider this question here with respect to two common treatments, antidepressant medication and cognitive behavioural therapy (CBT). Currently, there are limited data from randomized placebo‐controlled trials regarding the acceptability and efficacy of antidepressants. CBT trials appear to show more consistent treatment effects, albeit the feasibility of routine delivery remains unknown. No studies in dialysis patients has evaluated the combined effects of CBT with antidepressants. There is a need to consider pragmatic depression treatment trials in dialysis patients in order to increase study recruitment in order to have more reliable data from which to evaluate the evidence base. Furthermore, we need to understand why treatments work, and for whom do they work? Lastly, addressing issues surrounding treatment acceptability and implementation as part of regular care remain as key challenges that require attention if we are to improve the mental health of individuals on dialysis.

Experiences of a cognitive behavioural therapy (CBT) intervention for fatigue in patients receiving haemodialysis

“…The high treatment burden of dialysis and the presence of multimorbidities have also been previously raised as important challenges of this patient population (Reid et al, 2016), particularly depression (Chilcot & Hudson, 2019). Symptom burden is also high in kidney failure (Almutary et al, 2013).…”

The Case for Selective Withdrawal of Antidepressants in Patients with Advanced Kidney Disease

“…Three randomized, placebo-controlled trials of SSRIs in individuals with kidney disease [4][5][6] have failed to provide evidence of benefit while signposting increased risks of adverse events (reviewed in ref. 7). A recent randomized trial comparing sertraline with cognitive behavioral therapy in patients on dialysis showed a modest difference in favor of sertraline, 8 although there was no control group.…”

Sexual Dysfunction in Female Patients Undergoing Hemodialysis and Its Relationship With Anxiety and Depression

“…Depression is characterized by a persistent depressed (low) mood, feelings of worthlessness, a lack of positive affect, and a loss of interest in things one once enjoyed (anhedonia). It is a significant prognostic factor for mortality among dialysis patients (associated with a 50% increase in risk) [ 10 ]. In addition, it is associated with an increased risk of hospitalization, treatment nonadherence (shortened and skipped treatments), inflammation, and malnutrition in patients receiving dialysis [ 10 ].…”

“…It is a significant prognostic factor for mortality among dialysis patients (associated with a 50% increase in risk) [ 10 ]. In addition, it is associated with an increased risk of hospitalization, treatment nonadherence (shortened and skipped treatments), inflammation, and malnutrition in patients receiving dialysis [ 10 ].…”