Depression and anxiety in end-stage renal disease: epidemiology, diagnosis, and treatment

Juan D. Sossa, MD

Massachusetts General Hospital
Depression and anxiety in end-stage renal disease: epidemiology, diagnosis, and treatment

Scientific Abstract

Background: End-stage renal disease (ESRD) is a highly prevalent condition that affects over 700,000 Americans and is associated with impaired quality of life and increased rates of morbidity and mortality. Among individuals with ESRD, mood and anxiety disorders are common and can impact both psychological and physical health outcomes, yet research in this area is limited. In this narrative review, we provide an overview of the epidemiology, mechanisms, and treatment implications of depression and anxiety disorders in patients with ESRD.

Methods: Literature searches of PUBMED were performed to identify articles that examine the epidemiology, mechanisms, diagnosis, and treatment of depression and anxiety disorders in adults with ESRD.

Results: The prevalence of depression and anxiety disorders in patients with ESRD is elevated but quite variable (21-68% and 17-61% for depression and anxiety respectively), which can be explained by clinical and geographical differences in patient populations being studied. Biological (e.g., systemic inflammation, sympathetic hyperactivity and glucocorticoid excess) and behavioral (e.g., physical activity, diet, and medication adherence) mechanisms may mediate the relationships between depression/anxiety and renal health. Finally, regarding management, psychotherapy interventions (e.g., psychoeducation, mindfulness, narrative therapy) have been tested, with cognitive behavioral being the most studied and effective. In terms of pharmacotherapy, selective serotonin reuptake inhibitors appear to be safe and effective in this population, while tricyclic antidepressants are associated with higher risks of adverse effects.

Conclusions: Depression and anxiety are common and associated with poor health outcomes in ESRD. Both behavioral and biological mechanisms may explain these relationships. Fortunately, safe and effective treatments for depression and anxiety are available, though further study into their impact on renal outcomes is needed.

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research Areas

Authors

Juan D. Sossa, MD, Regina M. Longley, BA, Margaret Ford, RN, Christopher Celano, MD

Principal Investigator

Christopher Celano, MD

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