A practical approach to the treatment of depression in patients with chronic kidney disease and end-stage renal disease

S. Susan Hedayati, Venkata Yalamanchili, Fredric O. Finkelstein

Research output: Contribution to journalArticle

111 Citations (Scopus)

Abstract

Depression is a common, under-recognized, and under-treated problem that is independently associated with increased morbidity and mortality in CKD patients. However, only a minority of CKD patients with depression are treated with antidepressant medications or nonpharmacologic therapy. Reasons for low treatment rates include a lack of properly controlled trials that support or refute efficacy and safety of various treatment regimens in CKD patients. The aim of this manuscript is to provide a comprehensive review of studies exploring depression treatment options in CKD. Observational studies as well as small trials suggest that certain serotonin-selective reuptake inhibitors may be safe to use in patients with advanced CKD and ESRD. These studies were limited by small sample sizes, lack of placebo control, and lack of formal assessment for depression diagnosis. Nonpharmacologic treatments were explored in selected ESRD samples. The most promising data were reported for frequent hemodialysis and cognitive behavioral therapy. Alternative proposed therapies include exercise training regimens, treatment of anxiety, and music therapy. Given the association of depression with cardiovascular events and mortality, and the excessive rates of cardiovascular death in CKD, it becomes imperative to not only investigate whether treatment of depression is efficacious, but also whether it would result in a reduction in morbidity and mortality in this patient population.

Original languageEnglish (US)
Pages (from-to)247-255
Number of pages9
JournalKidney International
Volume81
Issue number3
DOIs
StatePublished - Feb 1 2012

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Chronic Renal Insufficiency
Chronic Kidney Failure
Depression
Therapeutics
Mortality
Music Therapy
Morbidity
Serotonin Uptake Inhibitors
Cognitive Therapy
Complementary Therapies
Sample Size
Antidepressive Agents
Observational Studies
Renal Dialysis
Anxiety
Placebos
Exercise
Safety
Population

Keywords

  • antidepressant
  • chronic kidney disease
  • depression
  • dialysis
  • treatment

ASJC Scopus subject areas

  • Nephrology

Cite this

A practical approach to the treatment of depression in patients with chronic kidney disease and end-stage renal disease. / Hedayati, S. Susan; Yalamanchili, Venkata; Finkelstein, Fredric O.

In: Kidney International, Vol. 81, No. 3, 01.02.2012, p. 247-255.

Research output: Contribution to journalArticle

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