Depression in Dialysis

Khuloud Shukha

Beth Israel Deaconess Medical Center, 185 Pilgrim Rd - Farr 833, Boston, MA 02215, USAUnited States

DOI: https://doi.org/10.17140/npoj-1-e001 · Published 2014-11-26 · Licence: https://creativecommons.org/licenses/by/4.0 · © 2014 The Author(s)

Also available as PDF (figures and tables appear in the PDF).

Keywords: the District of Columbia [DC], Puerto Rico, and the U.S. Virgin Islands)

Editorial Depression in Dialysis * *Corresponding author Khuloud Shukha* Khuloud Shukha, MD Clinical fellow in Nephrology Beth Israel Deaconess Medical Cen- Beth Israel Deaconess Medical Center, 185 Pilgrim Rd - Farr 833, Boston, MA 02215, USA ter, 185 Pilgrim Rd - Farr 833 Boston, MA 02215, USA Tel. 617-632-9880 Fax: 617-632-9880 When was the last time you talked to your dialysis patient about depression? And what E-mail: kshukha@bidmc.harvard.edu prompted you to start the conversation?

Volume 1 : Issue 1 It may be that our patients are not talking to us about the way they feel regarding the Article Ref. #: 1000NPOJ1e001 treatments we offer them, but they are definitely talking about it amongst themselves online; On a facebook page named “Dialysis suck,” and a website titled “Ihatedialysis.com”, where dialysis patients are able to express the distress and discomfort, the sadness and loneliness they Article History rd feel while on dialysis.

Received: November 23 , 2014 th Accepted: November 24th, 2014 th One dialysis patient writes about her experience in the first 4 months of dialysis from Published: November 26 , 2014 the latter website:” I had dialysis yesterday, and it seemed endless. It has been hurting, sting- ing, throbbing, infiltrating, fistula grams, balloons, rogue beings, narrow arteries, I went to bed Citation crying and I woke up crying. I am as alone as I can ever remember”, When I am not at dialysis, Shukha K. Depression in dialysis. I am spending my days off on the phone with doctors or on here or something like that, docu- Nephrol Open J. 2014; 1(1): e1- menting the latest damage so I never get a break. There is no joy to offset this experience”. e3. doi: 10.17140/NPOJ-1-e001 PREVALENCE OF DEPRESSION Depression is the most common psychiatric diagnosis in dialysis patients.2 Watnick et al found that depressive symptoms are very common at the start of dialysis therapy, as up to 44% of the patients she screened with the Beck Depression inventory (BDI) were depressed.3 It is estimated that up to 30% of the dialysis patients suffer from major depression.4 In com- parison, a study conducted by the CDC, which surveyed the prevalence of depression in 2006- 2008 in the general population, found that amongst 235,067 adults (in 45 states, the District of Columbia [DC], Puerto Rico, and the U.S. Virgin Islands), 9.0% met the criteria for current de- pression, including 3.4% who met the criteria for major depression. By state, age-standardized estimates for current depression ranged from 4.8% in North Dakota to 14.8% in Mississippi.5 BACK IN TIME In 1969, Beard interviewed 14 dialysis patients who were in the process of being as- sessed for a kidney transplant.6 He tells the story of each of them, their personalities and feel- ings towards their illness; he described their intimate experiences with fear of imminent death. Some of them controlled this anxiety by plain denial. After denial however, came sadness and hopelessness: “Patients with renal failure fear that their lives will be cut short by an untimely death, Copyright and as we listen closely we also hear these same patients express their fears that even if they ©2014 Shukha K. This is an open live, their lives may not be acceptable. This fear of death, coupled with a fear of life, is the access article distributed under the dilemma of the patient with chronic renal failure.” Creative Commons Attribution 4.0 International License (CC BY 4.0), Later, in 1971, Abram et al sent out questionnaires to 201 dialysis centers in the which permits unrestricted use, distribution, and reproduction in United States,7 surveying suicide attempts, withdrawal, death due to non compliance and any medium, provided the original accidents. 127 questionnaires were returned, and they included 3478 living and dead di- work is properly cited. alysis patients. Notably, the events questioned, were higher amongst patients getting in center dialysis, as compared to those getting dialyzed at home.

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