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Sunday, October 28, 2012

Depression in Patients with Chronic Kidney Disease


One in five patients with chronic kidney disease is depressed, even before beginning long-term dialysis therapy or developing end-stage renal disease. Chronic kidney disease patients with depression have poorer health outcomes than those without depression, even after adjusting for other factors that determine poor outcomes in these 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.

When you learn that your kidneys no longer work, it is normal to feel angry, fearful, and sad. Your doctor or nurse can answer medical questions, and a social worker at your unit can help you during this hard time. You have a lot to learn, and many changes to fit into your life. Write down your questions, so you can get them answered and reduce your worrying. You will have ups and downs as you adjust to kidney failure. This is normal. After you get used to your new life and get answers to your questions, you should start to feel better. Even though your dialysis schedule and new eating plan may be hard to get used to, they should start to feel like normal part of who you are and what you do each day.

Here are 9 effective ways to overcome depression with kidney disease:

1. Talk to social worker in your dialysis center.
2. Surround yourself with sights, sounds and smells that give you happiness.
3. Join depression and dialysis support groups
4. Start exercising, even a little.
5. Spend at least 10 minutes every day outside in the fresh air.
6. Reach out past yourself to help someone else.
7. Reach out to your family and friends for support.
8. Seek professional help - ask for a referral to a counselor.
9.  Ask your nephrologist about depression medications that can be used based on your kidney limitations.
Unfortunately we are unable to provide accessible alternative text for this. If you require assistance to access this image, please contact help@nature.com or the author
Proposed algorithm for management of depression in patients with CKD and ESRD. Alternative therapies include psychotherapy, counseling, social support, and music therapy. CKD, chronic kidney disease; ESRD, end-stage renal disease; MDE, major depressive episode



http://www.aakp.org/ has great article on this issue. For more information please click here
http://www.nature.com/ also has many good information for providers. please click here
When do you feel more depressed? During dialysis or before dialysis?