Depression in ESRD

What is depression and dysthymia?

Major depressive disorder is a common mood disorder, also known as clinical depression or simply, 'Depression'. Depression extends beyond the regular ups and downs of life experienced by most people. People who have depression experience certain emotional, physical, cognitive, and behavioral symptoms that impair their ability to meet the demands of everyday life, not just their ability to live fuller, more productive lives.

People with depression might have low energy, lose interest in activities they used to enjoy, feel hopeless, irritable, or sad most or all of the time. Their weight and appetite might change, and they might have a hard time concentrating or making decisions. They might withdraw from other people or think about suicide. Often, people who feel depressed also experience feeling anxious.

If someone experiences five or more of these symptoms in the same two week period or longer, they might have depression.

Dysthymia is long-term depression -- if someone has felt a depressed for at least two years, they may have dysthymia.

Who is affected by depression?

Depression can affect anyone — there is no single cause. Many things, like the stress of relationships, a chronic illness and living in or near poverty might contribute to depression. In addition, a person’s thoughts and behaviors can contribute to depression. While anyone can have depression, individuals undergoing hemodialysis are at increased risk — about four times as many patients on hemodialysis, compared to people in the general population, have depression (1).

Hemodialysis and cormorbid depression

When depression occurs simultaneously with other diseases, it is called comorbid depression. While depression is the most common psychological disorder in patients with End Stage Renal Disease (2), it is often not diagnosed. In depression, feelings of sadness, guilt, and hopelessness are persistent and can last weeks and even years if untreated. It can be especially hard to spot when some of these symptoms overlap with kidney problems or are due to the high burden of being on dialysis.

Depression is common and impacts a patient’s quality of life -- thus, patients on hemodialysis might benefit if screening for depression was incorporated into their routine care. The Beck Depression Inventory, the Hamilton Rating Scale for Depression and the Nine-Question Patient Health Questionnaire are some of the instruments that have been used to screen for depression in patients undergoing maintenance hemodialysis (3).

While there are very few studies on the treatment of depression among individuals undergoing hemodialysis, there is a large body of evidence that shows psychotherapy and antidepressant medication helps treat depression in the general population.

  1. Finkelstein FO, Finkelstein SH. Depression in chronic dialysis patients: assessment and treatment. Nephrol Dial Transplant. 2000;15(12):1911-3.
  2. Kimmel PL, Cukor D, Cohen SD, Peterson RA. Depression in end-stage renal disease patients: a critical review. Adv Chronic Kidney Dis. 2007;14(4):328-34.
  3. Cohen SD, Norris L, Acquaviva K, Peterson RA, Kimmel PL. Screening, diagnosis, and treatment of depression in patients with end-stage renal disease. Clin J Am Soc Nephrol. 2007;2(6):1332-42.