TY - JOUR
T1 - A practical approach to the treatment of depression in patients with chronic kidney disease and end-stage renal disease
AU - Hedayati, S. Susan
AU - Yalamanchili, Venkata
AU - Finkelstein, Fredric O.
N1 - Funding Information:
The views expressed here are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. This work was supported by VA MERIT grant CX000217-01 and NIH grant 1R01DK085512-01A1 awarded to Dr Hedayati. Support was also provided by the University of Texas Southwestern Medical Center O’Brien Kidney Research Core Center (P30DK079328).
PY - 2012/2/1
Y1 - 2012/2/1
N2 - 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.
AB - 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.
KW - antidepressant
KW - chronic kidney disease
KW - depression
KW - dialysis
KW - treatment
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U2 - 10.1038/ki.2011.358
DO - 10.1038/ki.2011.358
M3 - Review article
C2 - 22012131
AN - SCOPUS:84856719547
SN - 0085-2538
VL - 81
SP - 247
EP - 255
JO - Kidney international
JF - Kidney international
IS - 3
ER -