Chilcot Joseph, Hudson Joanna L
Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Semin Dial. 2019 May;32(3):210-214. doi: 10.1111/sdi.12755. Epub 2018 Nov 12.
Depression is undisputedly common among individuals with End-Stage Kidney Failure and associated with adverse outcomes. It is well recognized that effective treatments for depression are needed within routine dialysis care. But, are we any closer to successfully treating depression in dialysis patients? We consider this question here with respect to two common treatments, antidepressant medication and cognitive behavioural therapy (CBT). Currently, there are limited data from randomized placebo-controlled trials regarding the acceptability and efficacy of antidepressants. CBT trials appear to show more consistent treatment effects, albeit the feasibility of routine delivery remains unknown. No studies in dialysis patients has evaluated the combined effects of CBT with antidepressants. There is a need to consider pragmatic depression treatment trials in dialysis patients in order to increase study recruitment in order to have more reliable data from which to evaluate the evidence base. Furthermore, we need to understand why treatments work, and for whom do they work? Lastly, addressing issues surrounding treatment acceptability and implementation as part of regular care remain as key challenges that require attention if we are to improve the mental health of individuals on dialysis.
抑郁症在终末期肾衰竭患者中无疑很常见，且与不良后果相关。人们普遍认识到，在常规透析护理中需要有效的抑郁症治疗方法。但是，我们在成功治疗透析患者的抑郁症方面是否更接近目标了呢？我们在此就两种常见治疗方法——抗抑郁药物和认知行为疗法（CBT）来探讨这个问题。目前，关于抗抑郁药的可接受性和疗效，来自随机安慰剂对照试验的数据有限。CBT试验似乎显示出更一致的治疗效果，尽管常规实施的可行性仍然未知。尚无针对透析患者的研究评估CBT与抗抑郁药的联合效果。有必要考虑在透析患者中开展务实的抑郁症治疗试验，以增加研究招募人数，从而获得更可靠的数据来评估证据基础。此外，我们需要了解治疗为何有效，以及对哪些人有效？最后，如果我们要改善透析患者的心理健康，将围绕治疗可接受性和实施的问题作为常规护理的一部分加以解决，仍然是需要关注的关键挑战。
