Several studies have shown low treatment acceptance and, on average, only one-third of patients who may benefit actually receive antidepressant medication. Despite the high prevalence and clinical implications of depression, many patients remain untreated. 126 However, little is known about the influence of physical diseases, frailty, and cognitive impairment on the efficacy or feasibility of psychotherapy. Several studies have shown CBT to be successful in patients with ESKD 123–125 and, where possible, it should be considered the first-line treatment for patients with mild to moderate depression. The mainstay treatments are depression-specific psychotherapies, such as cognitive- behavioral therapy (CBT) or interpersonal therapy, and pharmacologic treatment with an antidepressant. The approach to treating depression in older patients is the same as for younger patients. 116 Furthermore, depression is associated with increased hospitalization and mortality in both CKD and ESKD. In addition to the well-recognized impact on QOL, 112–115 individuals who are maintained on dialysis and are older than 75 years are among those at highest risk of suicide. The recognition of depression in the older individual is important for several reasons. In addition often co-occurring with other GSs, depression can be associated with a high burden of pain, fatigue, poor sleep, pruritus, and nausea. Age-specific data are not available, but depression is often more common in socially isolated individuals and those with functional or cognitive impairment placing frail older individuals at increased risk. 110 These estimates may, however, be influenced by the observation, from a number of studies, that patients on dialysis are often unwilling to undergo formal psychiatric evaluation or treatment. Prevalence estimates of major depressive episodes, using formal psychiatrist interview assessments, are lower, ranging from 21% in earlier stages of CKD to 23% in those undergoing maintenance dialysis. The prevalence of depression varies, depending on the assessment tools used and the population studied, but, using self-report or screening questionnaires, it is estimated that close to 40% of those undergoing maintenance dialysis have some depressive symptomatology, even if they do not fulfill all criteria for a major depressive episode. Yu MB, BChir, in Brenner and Rector's The Kidney, 2020 Depressionĭepressive symptoms and clinical depression are common in patients across the complete spectrum of CKD.
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