Psychological intervention found to decrease depressive symptoms in hemodialysis patients.

PHILADELPHIA—Cognitive behavioral therapy may help combat depression and improve quality of life (QOL) for dialysis patients, a study shows.

Studies have suggested that 225-30% of dialysis patients suffer from major depression, and depression is with higher rates of hospitalization, other illnesses, and even higher mortality rates.

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Researchers in Brazil reported results from the first clinical trial of a psychological intervention in hemodialysis (HD) patients diagnosed with major depression. The study included 90 chronic HD patients, of whom half underwent three months of weekly 90-minute sessions of cognitive behavioral therapy led by a trained psychologist. 

The behavioral therapy sessions focused on issues related to kidney disease treatment and its effects on daily life. The sessions also addressed coping techniques, thinking and cognitive remodeling techniques, relaxation activities, social behavior abilities, as well as other issues. The other half of the cohort received the usual treatment offered in the dialysis clinic, without behavioral interventions. All patients filled out QOL questionnaires at the start of the study and again after three and nine months.

After three months of intervention, the group receiving cognitive behavioral therapy had a significant improvement in depressive symptoms, cognitive functions, and QOL scores compared with controls. These improvements persisted after six months of intervention. 

During the six-month period following the intervention, patients in the behavioral treatment arm received once-monthly maintenance sessions.At six months after the end of treatment, the behavioral intervention group had a mean 70% reduction in depression symptoms compared with only a 20% reduction in the control arm. The investigators concluded that cognitive behavioral therapy appears to be an effective strategy to treat depression in dialysis patients.

Findings were reported here at the American Society of Nephrology’s Renal Week conference.

“We were very surprised by our results and we were also very happy with the magnitude of the effects,” said Ricardo Sesso, MD, associate professor of medicine at the Federal University of Sao Paulo, Sao Paulo, Brazil.

“We have to pay attention to depression. It is second only to hypertension as a co-morbid condition in patients with end-stage renal disease. This [behavioral] intervention is harmless and has no side effects, and if administered by a trained person who has proven expertise in applying cognitive behavioral therapy. the results are very good.”

Nephrologists do not address mental health issues as aggressively as they should,” Dr. Sesso observed. Depression sometimes can be overlooked because of other concomitant medical conditions, he said.