Special Feature: Primary Care Issues for the Nephrologist Screening, Diagnosis, and Treatment of Depression in Patients with End-Stage Renal Disease

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. Several studies have been performed to validate the more common depression screening measures in patients with chronic kidney disease. The Beck Depression Inventory, the Hamilton Rating Scale for Depression, the Nine-Question Patient Health Questionnaire, and the Center for Epidemiologic Studies Depression Scale are some of the measures that have been used to screen for depression in patients with end-stage renal disease. Data suggest a higher Beck Depression Inventory cutoff score, of >14 to 16, will have increased positive predictive value at diagnosing depression in patients with end-stage renal disease. There are limited data on the treatment of depression in this patient population. Pharmacotherapy, including selective serotonin reuptake inhibitors, can be used if deemed clinically indicated, and no active contraindication exists. There are even fewer data to support the role of cognitive behavioral therapy, social support group interventions, and electroconvulsive therapy for treatment of depression in patients with chronic kidney disease. Larger randomized, controlled clinical trials aimed at the treatment of depression in patients with end-stage renal disease are desperately needed. Clin J Am Soc Nephrol 2: 1332–1342, 2007. doi: 10.2215/CJN.03951106

[1]  E. Češková,et al.  Monitoring of QT interval in patients treated with psychotropic drugs. , 2007, International journal of cardiology.

[2]  Scott D. Cohen,et al.  Nutritional status, psychological issues and survival in hemodialysis patients. , 2007, Contributions to nephrology.

[3]  Scott D. Cohen,et al.  Depression in end-stage renal disease hemodialysis patients , 2006, Nature Clinical Practice Nephrology.

[4]  P. Kimmel,et al.  Chronic nephropathies of cocaine and heroin abuse: a critical review. , 2006, Clinical journal of the American Society of Nephrology : CJASN.

[5]  W. Hall How have the SSRI antidepressants affected suicide risk? , 2006, The Lancet.

[6]  P. Kimmel,et al.  The predictive value of self-report scales compared with physician diagnosis of depression in hemodialysis patients. , 2006, Kidney international.

[7]  P. Kimmel,et al.  Depression in patients with end-stage renal disease treated with dialysis: has the time to treat arrived? , 2006, Clinical journal of the American Society of Nephrology : CJASN.

[8]  M. Crowell,et al.  Increased use of selective serotonin reuptake inhibitors in patients admitted with gastrointestinal haemorrhage: a multicentre retrospective analysis , 2006, Alimentary pharmacology & therapeutics.

[9]  A. Christensen,et al.  The role of depression symptoms in dialysis withdrawal. , 2006, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[10]  V. Serebruany Selective serotonin reuptake inhibitors and increased bleeding risk: are we missing something? , 2006, The American journal of medicine.

[11]  L. Moist,et al.  Screening for depression in chronic hemodialysis patients: Comparison of the Beck Depression Inventory, primary nurse, and nephrology team , 2006, Hemodialysis international. International Symposium on Home Hemodialysis.

[12]  Suzanne G. Watnick,et al.  Validation of 2 depression screening tools in dialysis patients. , 2005, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[13]  J. Ahlner,et al.  Selective serotonin reuptake inhibitor antidepressants and the risk of suicide: a controlled forensic database study of 14 857 suicides , 2005, Acta psychiatrica Scandinavica.

[14]  P. Kimmel,et al.  Suicide in the United States end-stage renal disease program. , 2005, Journal of the American Society of Nephrology : JASN.

[15]  R. Ostroff,et al.  Chronic renal failure, hemodialysis, and electroconvulsive therapy: a case report. , 2005, The journal of ECT.

[16]  P. Kimmel,et al.  PSYCHOSOCIAL FACTORS IN PATIENTS WITH CHRONIC KIDNEY DISEASE: Depression in End‐Stage Renal Disease Patients Treated With Hemodialysis: Tools, Correlates, Outcomes, and Needs , 2005, Seminars in dialysis.

[17]  J. Noh,et al.  Treatment of Depression and Effect of Antidepression Treatment on Nutritional Status in Chronic Hemodialysis Patients , 2005, The American journal of the medical sciences.

[18]  S. Friedman,et al.  Towards the Psychosocial Treatment of Depressed Patients on Dialysis , 2004 .

[19]  S. Fukuhara,et al.  Screening for depression in hemodialysis patients: associations with diagnosis, treatment, and outcomes in the DOPPS. , 2004, Kidney international.

[20]  J. Weilburg An overview of SSRI and SNRI therapies for depression. , 2004, Managed care.

[21]  M. Germain,et al.  Update on psychotropic medication use in renal disease. , 2004, Psychosomatics.

[22]  J. Goldberg,et al.  Antidepressant-induced mania: an overview of current controversies. , 2003, Bipolar disorders.

[23]  F. Goodwin,et al.  Antidepressants in bipolar disorder: the case for caution. , 2003, Bipolar disorders.

[24]  A. Kliger,et al.  RENAL RESEARCH INSTITUTE SYMPOSIUM: Chronic Peritoneal Dialysis Patients Diagnosed with Clinical Depression: Results of Pharmacologic Therapy , 2003, Seminars in dialysis.

[25]  R. Yoshimura,et al.  Higher Plasma 5-Hydroxyindoleacetic Acid Levels Are Associated with SSRI-Induced Nausea , 2003, Neuropsychobiology.

[26]  J. Coyne,et al.  Screening for depression in medical care: pitfalls, alternatives, and revised priorities. , 2003, Journal of psychosomatic research.

[27]  K. Budde,et al.  Impact of St John's wort treatment on the pharmacokinetics of tacrolimus and mycophenolic acid in renal transplant patients. , 2003, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[28]  D. Healy Lines of Evidence on the Risks of Suicide with Selective Serotonin Reuptake Inhibitors , 2003, Psychotherapy and Psychosomatics.

[29]  P. Kimmel Depression in patients with chronic renal disease: what we know and what we need to know. , 2002, Journal of psychosomatic research.

[30]  Suzanne G. Watnick,et al.  The treatment of depression in patients maintained on dialysis. , 2002, Journal of psychosomatic research.

[31]  A. Kliger,et al.  Identification and treatment of depression in a cohort of patients maintained on chronic peritoneal dialysis. , 2001, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[32]  P. Kimmel Psychosocial factors in dialysis patients. , 2001, Kidney international.

[33]  P. Kimmel,et al.  Compliance in hemodialysis patients: multidimensional measures in search of a gold standard. , 2001, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[34]  M. Whooley,et al.  Managing depression in medical outpatients. , 2000, The New England journal of medicine.

[35]  F. Finkelstein,et al.  Depression in chronic dialysis patients: assessment and treatment. , 2000, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[36]  F K Goodwin,et al.  Diagnosing bipolar disorder and the effect of antidepressants: a naturalistic study. , 2000, The Journal of clinical psychiatry.

[37]  O. Spigset,et al.  Citalopram pharmacokinetics in patients with chronic renal failure and the effect of haemodialysis , 2000, European Journal of Clinical Pharmacology.

[38]  J. Veis,et al.  High prevalence of alcoholism in dialysis patients. , 2000, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[39]  T. Breidenbach,et al.  Drug interaction of St John's wort with cyclosporin. , 2000, Lancet.

[40]  V. Snow,et al.  Pharmacologic treatment of acute major depression and dysthymia. American College of Physicians-American Society of Internal Medicine. , 2000, Annals of internal medicine.

[41]  P. Kimmel,et al.  Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis outpatients. , 2000, Kidney international.

[42]  P. Kimmel,et al.  Psychosocial factors in adult end-stage renal disease patients treated with hemodialysis: correlates and outcomes. , 2000, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[43]  S. Ayis,et al.  QTc-interval abnormalities and psychotropic drug therapy in psychiatric patients , 2000, The Lancet.

[44]  J. Coyne,et al.  Should we screen for depression? Caveats and potential pitfalls , 2000 .

[45]  G. Matzke,et al.  Drug prescribing in renal failure: Dosing guidelines for adults , 1999 .

[46]  O. Spigset Adverse Reactions of Selective Serotonin Reuptake Inhibitors , 1999, Drug safety.

[47]  W. Bennett,et al.  Interaction Between Tacrolimus and Nefazodone in a Stable Renal Transplant Recipient , 1998, Pharmacotherapy.

[48]  P. Kimmel,et al.  Psychosocial factors, behavioral compliance and survival in urban hemodialysis patients. , 1998, Kidney international.

[49]  P. Kimmel,et al.  Immunologic function and survival in hemodialysis patients. , 1998, Kidney international.

[50]  B. Grubb,et al.  Effect of sertraline hydrochloride on dialysis hypotension. , 1998, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[51]  C. Charytan,et al.  Fluoxetine in Depressed Patients on Dialysis , 1997, International journal of psychiatry in medicine.

[52]  P. Kimmel,et al.  Psychologic functioning, quality of life, and behavioral compliance in patients beginning hemodialysis. , 1996, Journal of the American Society of Nephrology : JASN.

[53]  P. Kimmel,et al.  Behavioral compliance with dialysis prescription in hemodialysis patients. , 1995, Journal of the American Society of Nephrology : JASN.

[54]  D. Nutt,et al.  The 5-HT3 antagonist ondansetron reduces gastrointestinal side effects induced by a specific serotonin re-uptake inhibitor in man , 1995, Journal of psychopharmacology.

[55]  C. Turner,et al.  Predictors of survival among hemodialysis patients: effect of perceived family support. , 1994, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[56]  R. W. Schultz,et al.  The effect of renal disease on the disposition of venlafaxine , 1994, Clinical pharmacology and therapeutics.

[57]  R. Kessler,et al.  The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. , 1994, The American journal of psychiatry.

[58]  P. Kimmel,et al.  Survival in hemodialysis patients: the role of depression. , 1993, Journal of the American Society of Nephrology : JASN.

[59]  P. Joyce,et al.  Elevated levels of acute phase plasma proteins in major depression , 1992, Biological Psychiatry.

[60]  P. Kimmel,et al.  Depression, Perception of Illness and Mortality in Patients with End-Stage Renal Disease , 1991, International journal of psychiatry in medicine.

[61]  J. Levenson,et al.  Psychological factors affecting end-stage renal disease. A review. , 1991, Psychosomatics.

[62]  R. Kohn,et al.  12-month outcome of patients with major depression and comorbid psychiatric or medical illness (compound depression). , 1991, The American journal of psychiatry.

[63]  G. Rodin,et al.  The Beck Depression Inventory as a Screening Device for Major Depression in Renal Dialysis Patients , 1989, International journal of psychiatry in medicine.

[64]  G. Hinrichsen,et al.  Depression in hemodialysis patients. , 1989, Psychosomatics.

[65]  M. Byrne,et al.  The pharmacokinetics of paroxetine in renal impairment , 1989, Acta psychiatrica Scandinavica. Supplementum.

[66]  S. Kennedy,et al.  Major depression in renal dialysis patients: an open trial of antidepressant therapy. , 1989, The Journal of clinical psychiatry.

[67]  D. Black,et al.  Treatment and outcome in secondary depression: a naturalistic study of 1087 patients. , 1987, The Journal of clinical psychiatry.

[68]  N. Mendell,et al.  Group participation and survival among patients with end-stage renal disease. , 1986, American journal of public health.

[69]  B. Hong,et al.  Diagnosis of depression in patients with end-stage renal disease. Comparative analysis. , 1985, The American journal of medicine.

[70]  F. Westervelt,et al.  Suicidal behavior in chronic dialysis patients. , 1971, The American journal of psychiatry.

[71]  A. Beck,et al.  An inventory for measuring depression. , 1961, Archives of general psychiatry.

[72]  R. Huisman,et al.  The effects of a low-to-moderate intensity pre-conditioning exercise programme linked with exercise counselling for sedentary haemodialysis patients in The Netherlands: results of a randomized clinical trial. , 2005, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[73]  R. Baldessarini,et al.  Antidepressant treatment in bipolar versus unipolar depression. , 2004, The American journal of psychiatry.

[74]  J. Concato,et al.  The prevalence and treatment of depression among patients starting dialysis. , 2003, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[75]  H. Akiskal Dysthymia and cyclothymia in psychiatric practice a century after Kraepelin. , 2001, Journal of affective disorders.

[76]  R. Spitzer,et al.  The PHQ-9: validity of a brief depression severity measure. , 2001, Journal of general internal medicine.

[77]  O. D. De León,et al.  Response to nefazodone in a depressed patient with end-stage renal disease. , 2001, General hospital psychiatry.

[78]  C. Schade,et al.  A ten-year review of the validity and clinical utility of depression screening. , 1998, Psychiatric services.

[79]  K. O'Donnell,et al.  The diagnosis of major depression in end-stage renal disease. , 1997, Psychotherapy and psychosomatics.

[80]  R. Friend,et al.  Serum albumin and depression in end-stage renal disease. , 1997, Advances in peritoneal dialysis. Conference on Peritoneal Dialysis.

[81]  E. Kouidi,et al.  Exercise renal rehabilitation program: psychosocial effects. , 1997, Nephron.

[82]  A. Dubey,et al.  Fluoxetine in depressed patients with renal failure and in depressed patients with normal kidney function. , 1996, General hospital psychiatry.

[83]  W. Katon Will improving detection of depression in primary care lead to improved depressive outcomes? , 1995, General hospital psychiatry.

[84]  J. Streltzer Diagnostic and treatment considerations in depressed dialysis patients. , 1983, Clinical and experimental dialysis and apheresis.