Living with renal failure presents significant physical and emotional challenges, including an increased risk of depression. While it’s important to find effective treatments for depressive symptoms, it’s necessary to choose medications carefully, as some may not be safe for people with impaired kidney function. Understanding which antidepressants are safe for use in renal failure can help you and your doctor make better decisions about managing depression while prioritizing kidney health.*

Understanding Renal Failure

Renal, or kidney, failure occurs when the kidneys can no longer function properly, leading to:

• A buildup of waste products, 
• Electrolyte imbalances, and 
• Fluid retention. 

These symptoms of kidney failure, whether from acute kidney injury (AKI) or end-stage kidney disease (ESKD), can lead to further complications and negatively impact other organs throughout your body.

Connection Between Renal Failure and Depression

Chronic kidney disease (CKD) is also linked to several neuropsychiatric conditions, including:

• Depression, 
• Anxiety,  
• Sleep disorders, and 
• Nerve pain. 

People with CKD are three times more likely to be depressed compared to the general population. Factors contributing to this include:

• Physiological changes, 
• The emotional impact of coping with the disease, 
• Social and psychological disruptions, 
• Concurrent health conditions, and 
• Medication side effects.

Safer Antidepressants for Kidney Failure

Certain depression medications are considered safer than others for people with advanced chronic kidney disease (CKD) and kidney failure.

Selective serotonin reuptake inhibitors (SSRIs). SSRIs are metabolized in the liver, rather than the kidneys, so are generally considered safe for people with kidney issues. Common SSRIs include fluoxetine (Prozac), sertraline (Zoloft), and citalopram (Celexa).

Serotonin-norepinephrine reuptake inhibitors (SNRIs). SNRIs are primarily metabolized in the liver, so are also considered suitable for people with kidney failure. Examples of SNRIs include venlafaxine (Effexor) and duloxetine (Cymbalta).

Riskier Antidepressants for Kidney Failure

Other antidepressants, such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), are occasionally prescribed, but are not first-line options due to their higher risk of serious side effects. 

These medications are metabolized and excreted through the kidneys, and in people with impaired kidney function or kidney failure, the accumulation of these drugs can increase the risk of toxicity. 

They are also not considered safe for people with renal failure because of their potential to cause adverse effects on the cardiovascular and central nervous systems. 

Depression is common among people with renal failure, and needs to be managed safely and effectively. Work closely with your healthcare provider to craft a treatment plan that’s tailored to your specific needs and goals. 

*Pedersen, T. (2023, May 8). What Antidepressants Are Safe for Adults with Renal Failure? Healthline. https://www.healthline.com/health/safe-antidepressants-in-renal-failure 

Responsum Health closely vets all sources to ensure that we always provide you with high-quality, reliable information. We do not, however, endorse or recommend any specific providers, treatments, or products, and the use of a given source does not imply an endorsement of any provider, treatment, medication, or procedure discussed within.