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Meta-Analysis
. 2016 May 23;2016(5):CD004541.
doi: 10.1002/14651858.CD004541.pub3.

Antidepressants for treating depression in adults with end-stage kidney disease treated with dialysis

Suetonia C Palmer  1 , Patrizia Natale, Marinella Ruospo, Valeria M Saglimbene, Kannaiyan S Rabindranath, Jonathan C Craig, Giovanni F M Strippoli
Affiliations
Meta-Analysis

Antidepressants for treating depression in adults with end-stage kidney disease treated with dialysis

Suetonia C Palmer et al. Cochrane Database Syst Rev. .

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.

Objectives: To evaluate the benefit and harms of antidepressants for treating depression in adults with ESKD treated with dialysis.

Search 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.

Selection criteria: 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)).

Data collection and analysis: 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).

Main 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.

Authors' 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.

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Conflict of interest statement

  1. Suetonia C Palmer: none known

  2. Patrizia Natale: none known

  3. Marinella Ruospo: none known

  4. Valeria Saglimbene: none known

  5. Kannaiyan S Rabindranath: none known

  6. Jonathan C Craig: none known

  7. Giovanni FM Strippoli: none known

Figures

1
1
Study selection flow diagram
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Antidepressant versus placebo, Outcome 1 Adverse events.
1.2
1.2. Analysis
Comparison 1 Antidepressant versus placebo, Outcome 2 All‐cause mortality.
1.3
1.3. Analysis
Comparison 1 Antidepressant versus placebo, Outcome 3 Withdrawal from treatment (antidepressant).
1.4
1.4. Analysis
Comparison 1 Antidepressant versus placebo, Outcome 4 End of treatment depression score.
2.1
2.1. Analysis
Comparison 2 Antidepressant versus psychological support, Outcome 1 Withdrawal from treatment (antidepressant).
2.2
2.2. Analysis
Comparison 2 Antidepressant versus psychological support, Outcome 2 End of treatment depression score.
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