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"Our study demonstrated that many patients on chronic hemodialysis have depressive symptoms but do not wish to receive aggressive treatment to alleviate these symptoms," said study co-leader Dr. Steven Weisbord.
"We also noted that when patients are willing to accept treatment, renal [kidney care] providers commonly do not prescribe treatment," said Weisbord, who's with the VA Pittsburgh Healthcare System.
When kidneys fail, dialysis treatment is needed to remove wastes and salt from the blood. It's often done at a hospital, dialysis center or at home with a special machine.
The study included 101 dialysis patients who completed monthly questionnaires about depression symptoms. They were followed for at least one year.
Thirty-nine patients were diagnosed with depression, based on assessments from a total of 147 sessions with health care staff.
But not all got treated with an antidepressant -- only 70 percent of sessions showed evidence that the patient was getting antidepressant treatment. And in 70 percent of cases where a nurse recommended that the patient intensify treatment, the patient refused to do so.
In 11 of 18 cases where patients agreed they needed depression medication, kidney specialists were unwilling to provide it, the study found.
The main reason patients refused to take antidepressants was because they felt their depression was attributable to an acute event, chronic illness or dialysis.
The study was published Jan. 26 in the Clinical Journal of the American Society of Nephrology.
A U.S. government improvement program for end-stage renal disease recently mandated that all dialysis facilities report individual patient screening and treatment plans for depression, Weisbord said.
"However, there is a paucity of evidence documenting the effectiveness of antidepressant treatment in this patient population and it remains unknown whether patients on dialysis want treatment for depression," he explained in a journal news release.
The prognosis for depressed dialysis patients can be bleak, said the authors of an accompanying commentary.
"Depression in people receiving dialysis treatment is associated with lower quality of life, increased hospitalizations and, in all likelihood, shortened survival," wrote Maree Hackett and Meg Jardine of the University of Sydney, Australia.
-- Robert Preidt
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