Identification and treatment of depression in a cohort of patients maintained on chronic peritoneal dialysis

Depression is the most commonly encountered psychological problem in patien ts with end-stage renal disease (ESRD). Depression has recently been shown to significantly impact on the morbidity and mortality of patients undergoi ng therapy for ESRD. The present study was designed as a pilot study to eva luate the feasibility of screening a large cohort of patients maintained on chronic peritoneal dialysis (CPD) for depression and then pharmacologicall y treating those patients assessed to have clinical depression. One hundred thirty-six patients maintained on CPD in our CPD unit were screened for de pression using the Beck Depression Inventory (BDI), a self-administered que stionnaire. Patients with scores of 11 or greater were referred to a traine d psychiatric interviewer for further evaluation to confirm the diagnosis o f clinical depression and determine whether the patient was a candidate for antidepressant medication. Sixty-seven patients had BDI scores of 11 or gr eater, and 60 of these patients were asked to participate in further evalua tion and possible therapy. Only 27 patients agreed to further study and wer e evaluated by a trained psychiatric interviewer for clinical depression. T wenty-three of these patients were assessed to have clinical depression, an d 22 patients were eligible for antidepressant medication based on their sc ores on the Hamilton Depression Scale and psychiatric interview. Eleven pat ients completed a 12-week course of therapy with antidepressant medication, and their BDI scores decreased from a mean of 17.1 +/- 6.9 (SD) to a mean of 8.6 +/- 3.2. Seven patients were treated with sertraline, 2 patients wit h bupropion, and 2 patients with nefazodone. It is concluded that (1) depre ssion is commonly present in patients maintained on CPD, (2) the BDI is a u seful tool to use to screen for clinical depression, and (3) clinical depre ssion is treatable with medication in this patient population. (C) 2001 by the National Kidney Foundation, Inc.