Comparative Efficacy of Therapies for Treatment of Depression for Patients Undergoing Maintenance Hemodialysis

Mehrotra, Rajnish; Cukor, Daniel; Unruh, Mark; Rue, Tessa; Heagerty, Patrick J.; Cohen, Scott; Dember, Laura M.; Diaz-Linhart, Yaminette; Dubovsky, Amelia N.; Greene, Tom; Grote, Nancy K.; Kutner, Nancy G.; Trivedi, Madhukar H.; Quinn, Davin K.; Halen, Nisha Ver; Weisbord, Steven D.; Young, Bessie A.; Kimmel, Paul L.; Hedayati, S. Susan

doi:10.7326/m18-2229

Cited by 83 publications

(86 citation statements)

References 46 publications

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“…2014) and a recent study has suggested a marginal benefit of sertraline over CBT (Mehrotra et al . 2019). We need further research on both pharmacological and non‐pharmacological approaches to the treatment of depression in this setting.…”

Section: Discussionmentioning

confidence: 99%

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Antidepressant Usage in Haemodialysis Patients: Evidence of Sub‐Optimal Practice Patterns

Guirguis

Chilcot

Almond

et al. 2020

Journal of Renal Care

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SUMMARY Background Depression is common in patients on haemodialysis and associated with adverse outcomes. Antidepressant use is widespread though evidence of efficacy is limited. Objectives To study antidepressant management practices in patients on haemodialysis with reference to NICE guidelines on management of depression in adults with chronic physical health problems. Design Prospective, multicentre, longitudinal cohort study with 6–15 month follow‐up. Participants Patients on haemodialysis established on antidepressant medication. Measurements Baseline assessment of mood was undertaken using Beck Depression Inventory (BDI‐II). Demographic, clinical and medication data were also collected. Changes in clinical and life circumstances and medication during follow‐up were recorded. At follow‐up, BDI‐II was reassessed and diagnostic psychiatric assessment undertaken. Results Forty‐one patients were studied. General practitioners were the main prescribers (68%). Ten agents were in use, the commonest being Citalopram (39%). Doses were often suboptimal. At baseline, 30 patients had high BDI‐II scores (≥16) and 22 remained high at follow‐up. Eleven had BDI‐II < 16 at baseline. In five, this increased on follow‐up to ≥16. Sixteen patients (39%) had no medication review during follow‐up, 14 (34%) had a dose review, and 11 (27%) a medication change. On psychiatric assessment at follow‐up, eight patients had current major depressive disorder (MDD), seven recurrent and 20 evidence of past MDD. Six displayed no evidence of ever having MDD. Conclusions Antidepressant management in patients on haemodialysis reflected poor drug selection, overprescription, under‐dosing and inadequate follow‐up suggesting sub‐optimal adherence to NICE guidelines. Most patients had high depression scores at follow‐up. Antidepressant use in haemodialysis requires reappraisal.

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Section: Discussionmentioning

confidence: 99%

“…In a third study there was a marginal, statistically but not clinically significant benefit on mood of sertraline over cognitive behavioural therapy (CBT), though there was no control group (Mehrotra et al . 2019). On the contrary, benefits of group (Duarte et al .…”

Section: Introductionmentioning

confidence: 99%

Antidepressant Usage in Haemodialysis Patients: Evidence of Sub‐Optimal Practice Patterns

Guirguis

Chilcot

Almond

et al. 2020

Journal of Renal Care

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“…MHD patients constitute a distinct and high-risk group [20], which is often associated with low immunity, decline or even loss the ability of work, substantial economic burden, inability to ful ll family responsibilities and participate in active social life, and suffer from various complications such as, muscle weakness, pruritus, fatigue, diabetic, hypertension, and restless legs. These factors are associated with lower QOL and poor clinical outcomes, leading to a higher risk of psychological crisis in MHD patients than that in the general population [21,22].…”

Section: Probable Causes Of Psychological Crisis In Mhd Patients In Tmentioning

confidence: 99%

Psychological status and intervention strategy of maintenance hemodialysis patients in COVID-19 epidemic

Nie

Zhu

Cui

et al. 2020

Preprint

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Background An outbreak of novel coronavirus disease 2019 (COVID-19) is a newly discovered contagious disease, which first broke out in China.Based on the psychological state, maintenance hemodialysis (MHD) patients might bear psychological problemsunder the COVID-19epidemic situation.To evaluate the psychological health of MHDpatients and explore the corresponding intervention strategies.Methods Acluster sampling approach was employed to obtain a sample of 206 MHD patients from two hospitals in Yunnan province: a COVID-19-designated hospital and a non-COVID-19-designated hospital. Post-traumatic stress disorder (PTSD) checklistwas used to assess the psychological status,while Kidney Diseaseand Quality of Life --Short Form(KDQOL-SF)was applied to assess the quality of life(QOL). The factorsinfluencing thepsychological status in MHD patients were employed by binary logistic regression.Results Among MHD participants (age 53.4 ± 15.3 years), 61 cases showed mild to moderate positive PTSD, and 72 casespresented severe positive PTSD.The level of education, capital income, hospital, depressive tendency, and QOL were the influence factors for the occurrence of PTSD. Moreover, the PTSD was negatively correlated with QOL and positively correlated with COVID-19-designated hospital and the depressive tendency.Conclusion During the COVID-19 epidemic, MHD patients, especially in COVID-19-designated hospitals, with low QOL and depressive tendency had a high incidence of positive PTSD, which requires prompt psychological counseling and effective measures from medical staff to ensure timely treatment of patients.

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“…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.…”

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Authors’ Reply

Wang

O’Hare

Maciejewski

2019

JASN

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We appreciate Dr. Yan's letter 1 and interest in our article. 2 We agree on the importance of accounting for differences in survival by race and age, especially in the dialysis population. As noted, these potential confounders are included in our adjusted models to evaluate the average effect of dialysis setting on survival (the main goal of our analysis).Although potentially important, an analysis of survival differences across settings by race and age would address a different research question. Below we present information on sample sizes and unadjusted 2-year mortality rates after stratification by age and race (Table 1). Although there are large differences in 2-year mortality rates across some of these groups, the trends largely mirror the patterns across dialysis settings reported in our article, with no indication of potential interaction effects by age or race, which we hope ameliorates Dr. Yan's concerns about these factors.Becauseofthelargenumberofcovariatesinthemodelandsmaller sample size in the Department of Veterans Affairs only cohort, formal stratified analysis could be problematic. With larger cohorts, examining the presence and magnitude of race/ethnicity and age differences in dialysis setting comparisons of patient outcomes are an important and promising area for future research.

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Comparative Efficacy of Therapies for Treatment of Depression for Patients Undergoing Maintenance Hemodialysis

Cited by 83 publications

References 46 publications

Antidepressant Usage in Haemodialysis Patients: Evidence of Sub‐Optimal Practice Patterns

Antidepressant Usage in Haemodialysis Patients: Evidence of Sub‐Optimal Practice Patterns

Psychological status and intervention strategy of maintenance hemodialysis patients in COVID-19 epidemic

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