We often talk about the effects of chronic kidney disease (CKD) on the body, but living with CKD may also impact mental and emotional health. Living with a chronic disease may leave you feeling overwhelmed and anxious. If these feelings are left unchecked, they may become more frequent, leading to the development of depression.
Speaking to your Circle of Care team may make it easier to help you feel less overwhelmed. In addition, you can learn coping mechanisms needed to navigate the emotional journey of chronic disease.
- Depression is often highly prevalent, under-recognized, and an under-treated condition in those with late-stage CKD and ESRD.
- Depression in dialysis patients is partly attributed to biological and physiological changes experienced during dialysis treatment.
- Don’t be afraid to ask for help; many resources and people are available in your CKD journey to help you cope healthily.
- Empowered peopletypically do better mentally and physically.
What is Depression?
Depression is a common mood disorder characterized by the persistent elevation and lowering of a person’s mood. Symptoms range from mild to severe and affect daily life, from how you think, feel, your sleep cycle, how you eat, and how you are able to handle certain situations. Other features of depression that may present include poor concentration, low energy, persistent negative feelings or thinking of hopelessness, lacking motivation, losing interest in things that you used to enjoy, and not wanting to be around people.
Different types of depression have been classified as follows:
- Clinical depression (major depressive disorder)
- Persistent depressive disorder (PDD)
- Disruptive mood dysregulation disorder (DMDD)
- Premenstrual dysphoric disorder (PMDD)
- Depressive disorder due to another medical condition
While depression may affect anyone, certain risk factors are associated with higher rates of depression. These factors may include significant life changes, brain chemistry, certain medications, chronic diseases, chronic pain, and genetics.
The gold standard to diagnose depression is the clinical interview, with self-reported questionnaires often being used in research and clinical settings for screening. Your healthcare provider may order other tests, such as blood tests, to see if your symptoms are caused by an underlying condition(s).
Treatment and Therapy Options
Depression is considered one of the most treatable mental health conditions, and most people typically respond well to treatment. Some treatment options include:
- Medications. Antidepressants (prescription medication) are prescribed to help change the brain chemistry that causes the symptoms of depression. There are several types of antidepressants available, and your healthcare provider will prescribe the one that best suits your symptoms and individual needs.
- Complementary medication. This treatment option may be used in conjunction with western medication. Examples of complementary medicine include massage, meditation, dietary supplements, music therapy, biofeedback, and guided imagery.
- Psychotherapies (talk therapies). In this treatment option, licensed psychologists apply scientifically validated approaches to help patients develop more effective and healthier habits. There are several approaches to psychotherapies, including interpersonal and cognitive-behavioral talk therapies.
- Brain Stimulation therapies. Brain stimulation therapy may help those who have depression with psychosis or severe depression. Types of brain stimulation therapies may include vagus nerve stimulation (VNS), electroconvulsive therapy (ECT), and transcranial magnetic stimulation (TMS).
Your healthcare provider will help you choose the right treatment plan for your depression based on your individual needs and medical situation.
Does CKD cause depression?
Getting a CKD or ESRD diagnosis may add additional stressors to a patient’s life, both mentally and physically. These additional stressors, in some situations, may include dietary constraints, financial burdens, the disease itself, and the inability to work because of dialysis.
Studies have shown that CKD patients who are not on dialysis have rates of depression up to three times higher than people in the general population. A reported 20% to 40% of patients across the CKD spectrum also suffer from depression.
The symptoms of depression may be missed because they are sometimes similar to those that present in kidney disease. Similar key symptoms of both conditions include insomnia, low energy, and loss of appetite or weight. Thus, depression is considered an overlooked complication of kidney disease.
Common feelings and experiences of depression in people with CKD may include:
- Feeling overwhelmed by the disease
- Feelings of hopelessness
- Difficulty sleeping and regular pain
- Anxiety that their quality of life is in the hands of carers and the disease
- Feelings of dependence on healthcare providers
Early screening is important for CKD and ESRD patients since depression is associated with poor outcomes, increased hospitalizations, and lower quality of life.
The most commonly used depression screening questionnaires for CKD and ESRD patients include:
- Beck Depression Inventory (BDI)
- Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR)
- Center for Epidemiologic Studies Depression Scale (CESD)
- Patient Health Questionnaire (PHQ-9)
Your healthcare provider will discuss different treatment options and plans with you that best suit your individual needs.
The National Kidney Foundation offers the following at-home tips for kidney disease patients:
- Exercise regularly.
- Try to get enough sleep every day (about 8 hours).
- Expect mood improvements to occur gradually and not immediately.
- Try to talk to someone.
Can depression cause kidney failure?
According to a new study, depression is associated with an increased risk of the development of kidney failure in the future. An older study showed that people with increased depressive symptoms have a higher risk of subsequent adverse kidney disease outcomes. Further investigations need to occur to establish which factors may explain the association with depression, i.e., important biological processes associated with depression and delayed seeking of medical care due to miscommunication between physician and patient.
Where can I go for Help?
Support groups provide a space for kidney patients and caregivers to gather and share similar experiences. Talk to your healthcare provider about organizations or groups they know of in the area.
Resources to find support:
- Renal Support Network. Renal support network facilitates online support meetings for both international and national groups.
- National Kidney Foundation (NKF). The NKF offers a support program called NKF peers; after filling out an online form or calling the number provided, you will be matched with a peer mentor. There is also a specific online CKD peer support community.
- American Association of Kidney Patients (AAKP). The AAKP has a locator feature for independent support groups in 34 states. Information is also provided about how to start your own support group.
At Panoramic Health, we understand that chronic kidney disease is a journey for patients and their families. Your Circle of Care team is equipped with social workers who can help you manage your kidney disease journey. Our priority is healthy patients; thus, we strive to deliver better outcomes and lower costs for everyone.
As we are a physician-led organization, we are uniquely positioned and qualified to provide holistic care for our patients through clinical engagement and our integrated value-based care platform.