When treating a chronic disease, mental health often goes overlooked. Fortunately, Western medicine has begun to realize the tremendous impact that mental and emotional health have on one’s physical health and overall wellbeing.

In the video, “Depression: the overlooked complication of kidney disease,” Associate Professor of Psychiatry and Behavioral Science at SUNY Downstate Medical Center, Daniel Cukor, Ph.D., explains:

• why it’s important to identify and treat depression in people with end-stage renal disease (ESRD);
• why that’s so difficult to do;
• why mental health treatment for patients with ESRD is so hard to come by;
• what patient resources are available.*

Why it’s critical to identify and treat depression

Studies show that depression is the biggest psychological issue faced by dialysis patients. It has been associated with:

• increased hospitalization;
• decreased quality of life; and
• increased mortality.

Depression has also been implicated in an unfortunate and unhealthy cycle of patients’ noncompliance with prescribed dialysis and diet regimens, resulting in faster progression of the disease, which often leads to deeper depression.

Potential diagnosis challenges in ESRD patients

People on dialysis deal with a wide variety of daily stressors that go beyond the immediate effects of their illness, including:

• functional limitations;
• changes in employment status;
• financial constraints; and
• heightened awareness of life expectancy.

These can lead to additional stress factors, such as changes in family dynamics, feelings of inadequacy as family providers or caretakers, and a sense of futility. It’s not surprising that this compounded negativity often leads to depression, depressive thinking, anxiety, and/or low energy.

For people with ESRD, these symptoms often overlap with medication side effects and common symptoms of uremia (high levels of urea and other nitrogen-based wastes in the blood that are usually filtered out by the kidneys). This can make it challenging to differentiate depression from other conditions.

Roadblocks for depression treatment at dialysis centers

Dr. Cukor describes a comprehensive approach to treating depression as:

• identifying patients with low mood;
• diagnosing depression;
• implementing stepped care;
• conducting an outcome evaluation;
• treating related conditions; and
• maintaining relapse prevention monitoring.

Unfortunately, this approach is nearly impossible to implement and sustain in the current structure of dialysis centers. There are too many unanswered questions concerning how each stage of the process would be carried out, with what instruments, by whom, and within what structure and time frame. The solution would have to be collaborative, and that takes time.

What resources are available to me?

If you’re struggling mentally and/or emotionally with your ESRD, you can do the following:

• speak with your dialysis social worker;
• reach out to your social network(s), religious community, or support group(s);
• find books to read to help self-educate and take advantage of the many free resources online; and
• seek professional help from an expert in your community who can provide therapy and any medication that may be necessary.

Dr. Cukor stated that the most important question to ask yourself is: “Am I getting the most out of life that my physical health will allow?” If the answer is no, it’s advisable to seek professional help for your mental health.

*American Kidney Fund. (2018, May 23). “Depression: The overlooked complication of kidney disease.”