Depression in End-Stage Renal Disease Patients

A substantial proportion of ESRD patients suffer significant morbidity and mortality from major depression and severe adjustment disorders. Remission of major depression is often achieved with medications alone, though a lower relapse rate is associated with treatment combining psychotherapy and antidepressant medication. Adjustment disorders are often responsive to psychotherapy, with or without adjunctive medication therapy. Because treatment of these conditions is very often effective, I would urge the nephrologist to build comfortable consultation and referral relationships with local psychiatrists such that even the patients who decline psychiatric referral can benefit from treatment with judicious use of antidepressant medication.