Diagnosis and treatment of depression in dialysis patients.

A high prevalence of depressive disorder, between 33% and 50%, has been reported in dialysis patients, although it is difficult to distinguish the physical symptoms like general fatigue, insomnia, and loss of appetite which are common among dialysis patients, from the psychiatric symptoms seen in depressive patients. Furthermore, co-occurrence of depression has been shown to be one of the risk factors of poor prognosis in dialysis patients, partly because depressed patients are less likely to adhere to their medication regimen and modify their lifestyle appropriately. The efficacy of psychiatric interventions, including pharmacotherapy and psychotherapy, has been examined for dialysis patients with co-occurrence of depression. Randomized controlled trials of psychiatric interventions for depression in dialysis patients are needed to investigate the impact of such interventions on depression, quality of life, and mortality.