Boosting Mood During Kidney Dialysis

Depression in kidney patients improved with cognitive behavioral therapy in new study

(RxWiki News) Physical illness can be a mental and emotional downer. Patients with kidney failure who are regularly hooked up to dialysis certainly aren't immune to sadness. Fortunately, there may be ways to lift their spirits and their physical health.

A recent study found that dialysis patients who underwent cognitive behavioral therapy not only had improved depression, but they also saw improvements in their physical health and quality of life.

"Ask your doctor about depression."

Daniel Cukor, PhD, of the psychiatry department at State University of New York (SUNY) Downstate Medical Center in Brooklyn, was lead author of this study.

Dr. Cukor and his co-researchers enrolled 59 patients from two New York dialysis centers in this study to find out what would happen when dialysis patients with moderate to severe depression underwent cognitive behavioral therapy.

Cognitive behavioral therapy directly links behaviors, including self-destructive ones, to people's thoughts. During such therapy, patients aim to change those thought patterns, their self-talk and reactions to difficult circumstances. With their therapist as a kind of coach, they set behavioral goals and solve behavioral problems, and think more deeply about how the mind can dictate behavior.

Of the 59 study participants, 33 were randomly selected to be given cognitive behavorial therapy during their dialysis treatments. The remaining 26 participants were placed on a wait list for therapy. Social workers with master's degrees who were part of each clinic's full-time staff administered the cognitive behavioral therapy.

The researchers monitored patients' health for three months. At the end of that period, the researchers wrote, 89 percent of those receiving therapy were not depressed.

Of the group that didn't get therapy, 38 percent were not depressed after three months.

The patients' mental wellness was determined based on what the patients self-reported and what the social workers measured, using several standard tests for ranking depression.

Based on what they self-reported on the Kidney Disease and Quality of Life standardized test, patients in the therapy group experienced better social interactions and emotional well-being and less sexual dysfunction than the group that didn't undergo therapy.

The therapy group also maintained a more healthy balance of fluids in their bodies following dialysis sessions.

"One of the primary barriers to appropriate depression care is the additional burden that an additional doctor’s appointment imposes," these researchers wrote.

"This study attempted to minimize this barrier, by offering the intervention during hemodialysis. We acknowledge that by reducing some of the effort required to see a mental health professional, we might be accessing participants who might not have been motivated enough to attend traditional mental health visits," they wrote.

According to Cliff Hamrick, LPC, a licensed professional counselor in private practice in Austin, Texas, "This study demonstrates the importance of the link between mind and body.

"Though taking care of one's medical needs is often apparent, taking care of one's mental health needs is also important. As the study showed, those that received counseling not only reported an improved emotional well-being, but also a better maintained balance of fluids. Taking care of the mind also takes care of the body," Hamrick told dailyRx News.

Anywhere from 20 percent to 44 percent of dialysis patients are depressed, according to these researchers, citing prior studies.

The researchers noted that either cognitive behavioral therapy or antidepressants known as selective serotonin reuptake inhibitors (SSRIs) — or both treatments — are commonly prescribed for people whose depression is not related to a psychosis that leaves them out of touch with reality. The side effects of such medications include nausea, vomiting, dry mouth, drowsiness, insomnia, sexual dysfunction, nervousness, weight gain and dizziness.

This study was published in the Journal of the American Society of Nephrology.

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, an arm of the National Institutes of Health. Study authors did not disclose any financial investments or other involvements that shaped study design, analysis or outcomes.

Review Date: 
October 15, 2013