Understanding Depression in Dialysis Patients

You may have thought to yourself at some point that one, two, or maybe more of your patients seem unhappy or even depressed. We don’t have a strong handle on the number of dialysis patients who struggle with depression because this has not been studied as closely as it needs to be. Based on what we do know, we can begin to shape a clinical picture of how many patients are depressed—about 20–30%. When you compare this to the general U.S. population—a little over 6% depressed—you can see it is more common in dialysis patients.

What Is Depression

We all have bad days. That’s not depression. Depression can last for weeks, months, or even years. Its impact is profound, debilitating, and in its worst state can lead people to think about, try, or even commit suicide. (On dialysis, this can take the form of stopping treatment.) Depression can be hard to detect because people may do their best to hide their feelings from you. They may be ashamed, or feel guilty or embarrassed about their “weakness.”

Depressed people don’t feel pleasure, have hope, or take part in the normal routines of life. Depressed people might have periods of great sadness that can last for long periods of time. They may find themselves crying and not able to stop. Or, they may seem angry and agitated, and lash out at others—like you. Some people with depression withdraw from life and get lost in their own feelings of despair and hopelessness.

Symptoms of depression a patient may feel include:

• Depressed mood
• Loss of interest or pleasure in things previously enjoyed
• Major weight loss or change in appetite
• Trouble sleeping—or sleeping too much
• Fatigue or loss of energy
• Strangely slow movements—or agitation
• Feeling worthless or guilty for no real reason
• Less ability to think or focus, or difficulty making decisions
• Thoughts of death, suicide, or making a plan to commit suicide

Depression in dialysis patients is linked with:

• Higher risk of early death
• Not following the dialysis treatment plan
• Greater risk of hospitalization
• Less exercise
• Diminished ability to learn
• Risk of suicide

Your Role

It is not your job to diagnose or treat depression. But there are things you can do to help reduce its impact on your patients. First, know that depression is a real disease, just like diabetes, high blood pressure, and kidney disease. Your patient may think that it is a weakness, a character flaw, or some sort of excuse. Depression is none of those things, and your patients who are suffering need to know this. You can also:

• Avoid judging
• Be supportive
• Be patient—overcoming depression is hard to do
• Give patients hope that their lives can be better with treatment for depression or by switching to a type of dialysis that gives them more control of their lives
• Refer the patient to your clinic’s social worker, doctor, or nurse