title: Antidepressants for treating depression in adults with end-stage kidney disease treated with dialysis.
abstract: BACKGROUND
  Depression affects approximately one-quarter of people treated with dialysis and is considered an important research uncertainty by patients and health professionals. Treatment for depression in dialysis patients may have different benefits and harms compared to the general population due to different clearances of antidepressant medication and the severity of somatic symptoms associated with end-stage kidney disease (ESKD). Guidelines suggest treatment of depression in dialysis patients with pharmacological therapy, preferably a selective serotonin reuptake inhibitor. This is an update of a review first published in 2005.
  
  
  OBJECTIVE
  To evaluate the benefit and harms of antidepressants for treating depression in adults with ESKD treated with dialysis.
  
  
  METHODS
  We searched Cochrane Kidney and Transplant's Specialised Register to 20 January 2016 through contact with the Information Specialist using search terms relevant to this review.
  
  
  METHODS
  Randomised controlled trials (RCTs) comparing antidepressant treatment with placebo or no treatment, or compared to another antidepressant medication or psychological intervention in adults with ESKD (estimated glomerular filtration rate < 15 mL/min/1.73 m(2)).
  
  
  METHODS
  Data were abstracted by two authors independently onto a standard form and subsequently entered into Review Manager. Risk ratios (RR) for dichotomous data and mean differences (MD) for continuous data were calculated with 95% confidence intervals (95% CI).
  
  
  RESULTS
  Four studies in 170 participants compared antidepressant therapy (fluoxetine, sertraline, citalopram or escitalopram) versus placebo or psychological training for 8 to 12 weeks. In generally very low or ungradeable evidence, compared to placebo, antidepressant therapy had no evidence of benefit on quality of life, had uncertain effects on increasing the risk of hypotension (3 studies, 144 participants: RR 1.72, 95% CI 0.75 to 3.92), headache (2 studies 56 participants: RR 2.91, 95% CI 0.73 to 11.57), and sexual dysfunction (2 studies, 101 participants: RR 3.83, 95% CI 0.63 to 23.34), and increased nausea (3 studies, 114 participants: RR 2.67, 95% CI 1.26 to 5.68). There were few or no data for hospitalisation, suicide or all-cause mortality resulting in inconclusive evidence. Antidepressant therapy may reduce depression scores during treatment compared to placebo (1 study, 43 participants: MD -7.50, 95% CI -11.94 to -3.06). Antidepressant therapy was not statistically different from group psychological therapy for effects on depression scores or withdrawal from treatment and a range of other outcomes were not measured.
  
  
  CONCLUSIONS
  Despite the high prevalence of depression in dialysis patients and the relative priority that patients place on effective treatments, evidence for antidepressant medication in the dialysis setting is sparse and data are generally inconclusive. The relative benefits and harms of antidepressant therapy in dialysis patients are poorly known and large randomised studies of antidepressants versus placebo are required.
authors.affiliation: Department of Medicine, University of Otago Christchurch, 2 Riccarton Ave, PO Box 4345, Christchurch, New Zealand, 8140.
authors.forename: Suetonia C
authors.initials: SC
authors.lastname: Palmer
authors.forename: Patrizia
authors.initials: P
authors.lastname: Natale
authors.forename: Marinella
authors.initials: M
authors.lastname: Ruospo
authors.forename: Valeria M
authors.initials: VM
authors.lastname: Saglimbene
authors.forename: Kannaiyan S
authors.initials: KS
authors.lastname: Rabindranath
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.forename: Giovanni F M
authors.initials: GF
authors.lastname: Strippoli
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015283:Citalopram / Q000627:therapeutic use; D003863:Depression / Q000628:therapy*; D005473:Fluoxetine / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000628:therapy*; D011613:Psychotherapy; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis / Q000523:psychology*; D020280:Sertraline / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D005473:Fluoxetine; D015283:Citalopram; D020280:Sertraline