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Depression in chronic kidney disease.

Key Concepts

1. Depression is the most common psychiatric disorder in patients with chronic kidney disease (CKD) and occurs at a rate four times greater than in those without any medical conditions. The reported prevalence rates of depression in patients with CKD range from 21.4% to 26.5% in stages 1-4 and 22.8% to 39.3% in stage 5.

2. The causes of depression are considered to be one-third genetic and two-thirds environmental. No single gene has been identified that can lead to depression.

3. Heightened levels of inflammation, such as seen in CKD, are associated with an increased risk of depression.

4. In addition to andedonia, an individual must have at least four additional symptoms to meet diagnosis criteria for depression. Among these are weight changes, appetite changes, alterations in sleep, poor focus, poor concentration, feelings of guilt, reduced energy, reduced psychomotor movement, and thoughts of suicide.

5. The criteria for making a diagnosis of depression is consistent for all age groups, yet there may be variations in presenting signs and symptoms in children and older adults.

6. Patients should be aware that most medications for depression will require 4 to 6 weeks of consistent use at an optimal dose before symptoms might be expected to leave.

7. There is a dearth of research available that clearly describes dose variation for the stages of chronic kidney disease and during hemodialysis. Most antidepressant medications are metabolized by the liver, but they may have metabolites that are excreted by the kidneys.

8. An interesting finding from the FREEDOM Study (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) revealed the benefit of increased frequency of dialysis for those with co-occurring depression.

9. Nonpharmacologic approaches that may be beneficial for treating depression in individuals with CKD include cognitive behavioral therapy, exercise, and yoga.

Depression is one of the most common mental health disorders in the world. Defined as a feeling of sadness or sense of loss of enjoyment and pleasure, one of these two characteristics combines with various somatic and cognitive problems that affect the person's ability to function (American Psychiatric Association [APA], 2013).

According to the National Institute of Mental Health (NIMH), in 2013, an estimated 15.7 million adults ages 18 or older in the United States had at least one major depressive episode in the past year (NIMH, 2013). This represented 6.7% of all U.S. adults. In 2013, 10.7 percent of the population ages 12 to 17 (2.6 million youths) had a major depressive episode during the past year. In the same year, 7.7% of the population ages 12 to 17 (1.9 million youths) had past-year major depressive episodes with severe impairment in one or more areas of their life (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014).

According to the World Health Organization (WHO, 2010), major depression also carries the heaviest burden of disability among mental and behavioral disorders, accounting for 3.7% of all U.S. disability-adjusted life years (DALYs), and 8.3% of all U.S. years lived with disability (YLDs) (Lepine & Briley, 2011). Depression is the most common psychiatric disorder in those with chronic kidney disease (Young et al., 2010) and occurs in these individuals at a rate four times greater than in those without any medical conditions (Zalai, Szeifert, & Novak, 2012).

Chronic kidney disease (CKD) is a progressive problem that affects about 10% of the world's population (Palmer et al., 2013b). Marked by kidney damage and a gradually deteriorating kidney function that is often permanent, this condition is divided into five stages measured by variable glomerular filtration rate (GFR) such as in stage 1, where the GFR is more than 90 mL/min/1/73 [m.sup.2], to stage 5, where the GFR is less than 15 mL/minute/1.73 [m.sup.2] (Andrade & Sesso, 2012).

Untangling depression from the basic physiologic symptoms of CKD itself is often a challenge. Yet this is an important process. Evidence reveals that individuals with chronic diseases are prone to depression (Olver & Hopwood, 2012). Those with CKD are found to have even more problems with depression than in other chronic illnesses (Kellerman, Christensen, Baldwin, & Lawton, 2010; Palmer et al, 2013a)
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Title Annotation:CHAPTER 25
Author:Lieser, Carol S.
Publication:Nephrology Nursing Journal
Article Type:Disease/Disorder overview
Date:Jan 1, 2017
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