TY - JOUR
T1 - Diagnosis and Management of Depression in Patients With Kidney Disease
AU - Gregg, Lucile Parker
AU - Trombello, Joseph M
AU - McAdams, Meredith
AU - Hedayati, S. Susan
N1 - Funding Information:
Financial support: This work was supported in part by the Houston VA Health Services Research and Development Center for Innovations grant CIN13-413; and by grant 1R01DK124379-01 from the National Institute of Diabetes and Digestive and Kidney Diseases and by the Yin Quan-Yuen Distinguished Professorship in Nephrology at the University of Texas Southwestern Medical Center (Dallas, TX) (S.S.H.).
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/11
Y1 - 2021/11
N2 - Depression disproportionately affects patients with kidney disease, including those with nondialysis chronic kidney disease, end-stage kidney disease requiring dialysis, and kidney transplant recipients. Patients across the spectrum of kidney disease should be screened for depression every 6 to 12 months using self-report questionnaires, followed by an interview with a clinician to confirm the presence of sadness or anhedonia when depressive symptoms are identified. Pharmacologic treatment with selective serotonin reuptake inhibitors has not consistently shown benefit compared with placebo and may be associated with serious adverse outcomes including cardiovascular events, bleeding, and fractures. However, based on the availability of alternative therapies, a watchful trial with close monitoring for therapeutic and adverse effects is reasonable. Several clinical trials have suggested that cognitive behavioral therapy and physical activity improve depressive symptoms when compared with a control group. Given the low risk associated with these therapies, they should be recommended to patients who have access and are amenable to such interventions. Future trials are needed to study therapeutic options for depression in nondialysis chronic kidney disease, peritoneal dialysis, or kidney transplant recipients, as well as alternative pharmacologic therapy and combination therapies. Given improvement in depressive symptoms with placebo in existing trials, inclusion of a control group is paramount.
AB - Depression disproportionately affects patients with kidney disease, including those with nondialysis chronic kidney disease, end-stage kidney disease requiring dialysis, and kidney transplant recipients. Patients across the spectrum of kidney disease should be screened for depression every 6 to 12 months using self-report questionnaires, followed by an interview with a clinician to confirm the presence of sadness or anhedonia when depressive symptoms are identified. Pharmacologic treatment with selective serotonin reuptake inhibitors has not consistently shown benefit compared with placebo and may be associated with serious adverse outcomes including cardiovascular events, bleeding, and fractures. However, based on the availability of alternative therapies, a watchful trial with close monitoring for therapeutic and adverse effects is reasonable. Several clinical trials have suggested that cognitive behavioral therapy and physical activity improve depressive symptoms when compared with a control group. Given the low risk associated with these therapies, they should be recommended to patients who have access and are amenable to such interventions. Future trials are needed to study therapeutic options for depression in nondialysis chronic kidney disease, peritoneal dialysis, or kidney transplant recipients, as well as alternative pharmacologic therapy and combination therapies. Given improvement in depressive symptoms with placebo in existing trials, inclusion of a control group is paramount.
KW - Chronic kidney disease
KW - cognitive behavioral therapy
KW - depression
KW - end-stage kidney disease
KW - kidney transplant
KW - physical activity
KW - selective serotonin reuptake inhibitor
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U2 - 10.1016/j.semnephrol.2021.10.003
DO - 10.1016/j.semnephrol.2021.10.003
M3 - Article
C2 - 34973695
AN - SCOPUS:85119208832
SN - 0270-9295
VL - 41
SP - 505
EP - 515
JO - Seminars in nephrology
JF - Seminars in nephrology
IS - 6
ER -