Treatment of depression and effect of antidepression treatment on nutritional status in chronic hemodialysis patients.
BACKGROUND
Depression, which is the most common psychological complication in patients with end-stage renal disease (ESRD), has an impact on the clinical outcome and is associated with malnutrition in chronic hemodialysis patients. This study evaluated the effect of antidepression treatment on nutritional status in depressed chronic hemodialysis patients.


METHODS
Sixty-two ESRD patients who underwent dialysis for more than 6 months were interviewed and completed a Beck Depression Inventory assessment. Thirty-four patients who had scores greater than 18 on the Beck Depression Inventory score and met Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for major depressive disorder were selected to receive paroxetine 10 mg/day and psychotherapy for 8 weeks. The remaining 28 patients were assigned to the control group. Change in the severity of depressive symptoms was ascertained by administering the Hamilton Depression Rating Scale. Nutritional status was evaluated by normalized protein catabolic rate, serum albumin and blood urea nitrogen level.


RESULTS
All patients successfully completed 8 weeks of antidepression treatment. Antidepression treatment decreased the severity of depressive symptoms (Hamilton Depression Rating Scale score: 16.6 +/- 7.0 versus 15.1 +/- 6.6, P < 0.01) and increased normalized protein catabolic rate (1.04 +/- 0.24 versus 1.17 +/- 0.29 g/kg/day, P < 0.05), serum albumin (37.3 +/- 2.0 versus 38.7 +/- 3.2 g/l, P < 0.005), and prehemodialysis blood urea nitrogen level (24.3 +/- 5.6 versus 30.2 +/- 7.9 mmol/L, P < 0.001). In the control group, no change was noted during the study period.


CONCLUSIONS
This study suggests that antidepressant medication with supportive psychotherapy can successfully treat depression and improve nutritional status in chronic hemodialysis patients with depression.
Koo
Ja-Ryong
JR
Division of Nephrology, Department of Internal Medicine, College of Medicine, Hallym University, Chunchon, Kangwon Do, South Korea. jrkoo@hallym.ac.kr
Yoon
Jong-Yoo
JY
Joo
Min-Ha
MH
Lee
Hyung-Seok
HS
Oh
Ji-Eun
JE
Kim
Seong-Gyun
SG
Seo
Jang-Won
JW
Lee
Young-Ki
YK
Kim
Hyung-Jik
HJ
Noh
Jung-Woo
JW
Lee
Sang-Kyu
SK
Son
Bong-Ki
BK
D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status / Q000187:drug effects*; D017374:Paroxetine / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000523:psychology*
D018687:Antidepressive Agents, Second-Generation; D017374:Paroxetine