Screening, Diagnosis, and Treatment of Depression in Patients with End-Stage Renal Disease

Abstract

Depression is common in patients with end-stage renal disease and has been linked to increased mortality. Screening for depression in the general medical population remains controversial; however, given the high prevalence of depression and its significant impact on morbidity and mortality, a strong case for depression screening in patients with end-stage renal disease can be made.

Psychosocial Aspects of Chronic Disease

“…2,3,34,120,121 Pharmacologic options to treat depression include selective serotonin reuptake inhibitors (SSRIs), as well as the newer selective serotonin and norepinephrine reuptake inhibitors. 24,34,115,[122][123][124][125] Other agents such as tricyclic antidepressants, monoamine oxidase inhibitors, and St. John's wort should be avoided if possible because of potential exacerbation of common adverse events in dialysis patients, including drug-drug interactions, arrhythmias, and orthostatic hypotension. 24,115,122,125 Patients who receive these antidepressant medications should be closely monitored for development of a prolonged corrected QT interval.…”

“…24,34,115,[122][123][124][125] Other agents such as tricyclic antidepressants, monoamine oxidase inhibitors, and St. John's wort should be avoided if possible because of potential exacerbation of common adverse events in dialysis patients, including drug-drug interactions, arrhythmias, and orthostatic hypotension. 24,115,122,125 Patients who receive these antidepressant medications should be closely monitored for development of a prolonged corrected QT interval. 126,127 If this complication occurs, the antidepressant medication should be discontinued.…”

“…128 -131 24,115,132 A strategy is to reduce the initial starting dose of SSRIs by one third. 115,125,133 An important adverse event associated with SSRIs that should be considered before prescribing these agents is the potential to increase the risk of mania in bipolar disorder patients who are improperly diagnosed with depression. 115,134 -137 Initial administration of SSRIs may also be associated with an increased risk of suicide during the initial period of administration; however, this issue remains controversial.…”

“…138 -140 SSRIs may also exacerbate nausea and bleeding, two common uremic symptoms. 115,121,[141][142][143][144][145][146][147] There have been no randomized clinical trials assessing the efficacy of psychotherapy for treating depression in this population, 120,148 but there is some clinical evidence that these interventions might be effective. 149 Optimal treatment of depressive disorders in ESRD patients, therefore, may involve medical treatment, psychotherapy, or their combination.…”

Depression and coping in adults undergoing dialysis for end‐stage renal disease

“…However, Craven et al (1988) found that only 8.1% met Diagnostic and Statistical Manual, Third Edition, criteria for major depression. Kimmel and colleagues reported that among outpatients who were treated with HD, approximately 25% of them were depressed, with mean BDI scores that corresponded to mild levels of depression in the general population (Cohen et al, 2007).…”