Depression in patients with CKD and ESRD

Abstract Depression is disproportionally prevalent in end-stage renal disease (ESRD) populations. The screening for depression is complicated by the overlap of symptoms of uremia and dialysis treatment and the lack of information regarding screening techniques and the utility of instruments for diagnosis of depression in patients with ESRD. The major screening instruments used are reviewed, and recommendations about their utility in this population are made. The literature on the pharmacological treatment of depression is reviewed in depth. The chapter includes consideration of the major classes of antidepressants and their use in ESRD populations. There is a discussion of the nonpharmacological approaches to treating comorbid depression in ESRD patients, focusing on cognitive behavioral therapy and exercise interventions. The chapter ends with a discussion of the challenges and offers solutions for the widespread adoption of depression treatment in dialysis centers.