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Mental Health Management

Depression and Chronic Kidney Disease

Depression has been called the common cold of mental health. That’s because it’s much more prevalent than people think. Anyone can suffer from depression—not just those with chronic kidney disease (CKD) or who are on dialysis. Just because someone has kidney disease, or end stage renal failure, doesn’t mean they will experience depression.

The worst result of depression is that it robs a person of their happiness over a period of weeks, months or even years. More than feeling a little sad or out-of-sorts for a day or two, depression is an illness that should be treated by a professional in the same way you would treat diabetes or high blood pressure. Having depression in no way implies that a person has flaws in their character.

Seek Professional Help

Depression can mimic the symptoms of many other illnesses. Only a qualified professional can make a diagnosis based on the description of your symptoms.

Have you experienced any of the following?

  • Constant sadness, especially when circumstances would lead most people to be happy
  • More difficulty than usual with making decisions
  • Easily upset and/or more irritable than usual
  • Being tried all the time
  • Sleeping more or less than usual
  • Waking up early in the morning, if this had not been your normal routine
  • Not wanting to eat or wanting to eat more than usual
  • Constant thoughts of death (Seek professional help immediately.)

If you have experienced any of the symptoms above, talk to your RMA doctor. Your RMA doctor is familiar with your medical conditions and general life situation. He or she can help you sort out what is depression and what might be something else. For those with kidney disease or on dialysis there could be physical contributors.

For example, if you are feeling down because you are tired all the time, perhaps you have anemia, which can be treated with medicines. By reviewing your symptoms and talking about what you are feeling with your doctor, he or she can determine if you are suffering from depression or if there is some aspect of kidney disease that should be treated.

The most dangerous feature of depression is that if it is left untreated it can lead someone to be suicidal. If you ever have thoughts that you would be better off dead than continuing to live, please tell someone today. People and places you can turn to for help include:

  • A health care professional
  • Your caregiver
  • Your spouse or significant other
  • Your religious leader or pastor
  • A trusted friend or family member
  • The suicide hot line by calling 1-800-SUICIDE
  • Emergency response by calling 9-1-1

Keep telling people until someone listens to you and helps you, this could save your life.

How is depression treated?

Depression is typically treated in one or a combination of two ways:  with medications and/or with psychotherapy, also known as “talk therapy.”

Medications can only be prescribed by a qualified doctor or nurse practitioner. Psychiatrists are physicians who have specialized knowledge and training in the use of medications to affect what is going on in the brain to cause depression. It is always best to check with your Nephrologist before seeing a psychiatrist, as many medicines used to treat depression require dosage adjustments for those who are at end stage renal disease.

Many medications in use today do not have the side effects that were common ten or more years ago. Some medicines do, however, take a few weeks to start helping you feel better. Your doctor or nurse practitioner may manage your medications, or they may prefer that you see a psychiatrist. Typically psychiatrists can be found through your mental health benefit, if you have insurance, and often you do not need any kind of referral from your primary care doctor. If you do not have insurance, you can be seen by a psychiatrist through your county department of social services.

It is important that the prescribing physician be aware that you have chronic kidney disease or are on dialysis. The doctor will also want to know all of the other prescriptions you are taking. This knowledge will help the doctor determine the best medicine to treat your depression and maintain your overall health.

Psychotherapy or “talk therapy” involves a series of meetings with a mental health professional. Your state licenses, or otherwise regulates, psychotherapists so that the care you get meets quality standards. Psychotherapists can be:  psychiatrists, psychologists, social workers, nurses, licensed professional counselors or Christian counselors. The first time or two you meet with a therapist; he or she will work with you to determine what is causing your depression and how they can assist you.

There are many different approaches to psychotherapy, and most therapists are skilled in determining what will be the best one for you. Therapy can range from a few sessions to many sessions. Sometimes the length of time and the number of sessions is determined by what you can afford and/or what your insurance will cover. It is important that you feel your therapist is someone you can be honest with and that you can trust. Therapists will understand if you feel you need to be seeing someone else. All licensed therapists operate under strict codes of ethics and confidentiality so that you can be assured that you are safe and your privacy will be respected.

If your place of employment has an Employee Assistance Program, confidential help is usually available twenty-four hours per day from professionals who do not have any requirement to say anything about your situation to your employer. Your insurance card may have a phone number on it for “behavioral mental health” where you can get help finding a mental health professional that is covered by your insurance. If you do not have insurance coverage for mental health, help is available through your county department of social services.

Summary

Depression can have many causes. In the case of someone who has just been diagnosed with chronic kidney disease there may be a lot of information to process about your physical health, which may lead to strong emotions about your life and how it may change. Similarly, once a person reaches end stage renal disease and begins dialysis, there are lifestyle adjustments to be made that could bring up feelings of despair. Many times these feelings are temporary; however, if you find you’re having difficulty don’t hesitate to get the help you need.

Depression is a very treatable disease. Just like you get medical treatment for your renal disease there are treatments available for depression. Don’t let depression rob you of your happiness.

Patients with chronic kidney disease (CKD) have a high prevalence of depression and should be screened routinely for this condition, according to the results of an observational cross-sectional study reported in the September issue of the American Journal of Kidney Diseases.

“Depression is prevalent in long-term dialysis patients and is associated with death and hospitalization, “Whether depression is present through all…CKD stages or appears after dialysis therapy initiation is not clear. We determined the prevalence of a major depressive episode and other psychiatric illnesses by using a structured gold-standard clinical interview and demographic and clinical variables associated with major depressive episode in patients with CKD.”

“Because patients in the early stages of chronic kidney disease are at increased risk for clinical depression, we as nephrologists should consider screening our patients for depression in clinic,” Dr. Hedayati said in a news release. “Chronic kidney disease patient depression numbers may be higher due to the presence of the same simultaneously occurring conditions that resulted in progressive kidney disease, such as diabetes and atherosclerotic vascular disease. Alternatively, patients such as diabetics, who are depressed, may develop progressive kidney disease because of non-adherence to medications and physicians’ advice.”

Limitations of this study include its setting in a single center; relatively small sample size; and participants mostly male veterans, limiting generalizability. To determine the safety and efficacy of antidepressant medication in patients with CKD, the Chronic Kidney Disease Antidepressant Sertraline Trial (CAST) is now underway by Dr. Hedayati and colleagues.

“Special emphasis should be placed on the depression screening of patients with CKD with diabetes mellitus because diabetic participants with CKD were twice as likely to have a major depressive episode compared with nondiabetic participants with CKD,” the study authors conclude. “Future large prospective studies are warranted to investigate whether depression also is related to poor outcomes in patients with CKD as in patients with ESRD [end-stage renal disease] on long-term dialysis therapy and whether treatment of depression will make a difference in the quality of life and clinical outcomes of patients with CKD before and after dialysis therapy initiation.”