What Is The Treatment for Depression In Hemodialysis Patients
Depression is a common complication in maintenance hemodialysis (MHD) patients. Approximately 22.8%-62.0% of maintenance hemodialysis patients have significant depressive symptoms, which can significantly affect the prognosis and life quality of patients.
How does depression affect MHD?
1. Cardiovascular disease
Cardiovascular disease is the main cause of death in ESRD (End Stage Renal Disease) and depression can increase the risk of cardiovascular death in MHD patients. For example, heart failure and coronary atherosclerotic heart disease, the specific mechanism may be associated with excessive smoking, alcohol abuse and increased cortisol.
Depression is an independent risk factor for malnutrition in MHD patients, and malnutrition is an important factor that seriously affects the prognosis of patients. MHD patients with depression often have inadequate dietary intake and inadequate dialysis, which will cause the lack of trace elements and protein, malnutrition and body dysfunction. Hypophosphatemia may delay wound healing and may reduce the contractile force of the diaphragm leading to respiratory failure. Zinc deficiency can lead to poor wound healing and can damage the immune system by inhibiting T cell proliferation, increasing the risk of infection in MHD patients. And copper deficiency is associated with megaloblastic anemia.
3. Inflammatory response
Depressed patients are often accompanied by immune inflammatory response. Malnutrition caused by depression can stimulate the activation of inflammatory cells and secretion of inflammatory mediators, such as interleukin-1 (il-1), interleukin-6 (il-6) and tumor necrosis factor (TNF). These inflammatory factors not only reduce the release of biogenic amines such as norepinephrine in the brain, but also stimulate the hypothalamic-pituitary-adrenal axis, promote the secretion of cortisol, and eventually aggravate the occurrence of cardiovascular events. In MCD patients, residual kidney function, dialysis materials and complications can cause increased circulatory inflammation and cytokines.
How to treat depression of MHD patients?
1. Non-drug treatment
Psychotherapy cognitive behavioral therapy (CBT) is the most important psychological intervention for depression. CBT refers to the treatment of a series of physical and psychological problems by correcting irrational cognitive concepts and/or behaviors to change adverse emotional reactions. Currently, studies have shown that CBT can improve the prognosis of MHD patients in terms of sleep quality, renal disease, social quality and overall health. In addition, appropriate functional exercise can improve the symptoms of depression in MHD patients.
2. Drug therapy
Antidepressant drugs are necessary for people with depression who have physical illness. Currently guidelines recommend preferred selective serotonin (5-ht) and then suppressing drugs for MHD dialysis.
Dialysis can cause a series of complications including depression. It is not a best treatment for kidney patients. Here we recommend natural and systematic Chinese medicine treatments which can repair kidney damage and improve renal function. In this way, you can avoid or at least reduce dialysis. About more information, you can leave a message below or consult our online doctor directly.
***Please seek professional medical advise for the diagnosis or treatment of any ailment, disease or medical condition. This article is not intended to be a substitute for the advice of a licensed medical professional.***