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

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Authors


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 m2).

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.

Plain language summary

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

Background

People treated with dialysis frequently experience depression and anxiety. Depression in this situation is linked to poor quality of life and increased complications, such as needing to be admitted to hospital, or stopping dialysis treatment. Patients, their families, and health care workers agree that caring for depression symptoms appropriately and finding effective treatments is really important. Antidepressant drugs may not be removed from the body as quickly for people with kidney disease and so may cause more side effects. Despite depression being very common and treatment having potentially different side-effects compared with people without kidney disease, a previous version of this review in 2005 found only a single research study. It is unknown whether antidepressant treatment works and is safe for people with kidney failure.

A summary of whether antidepressant therapy works and is safe in people with kidney failure would be relevant to patients and their families, health care workers, and policy makers to generate patient-centred treatment policies.

This review looks at whether we know whether drug treatment works to improve symptoms of depression in adults treated with dialysis without causing common and severe side effects.

Study characteristics

We included all studies which have looked at drug treatment against placebo (sugar pill) or other kinds of mental health support. People included in the studies had an equal chance of receiving either treatment.

Key results

Unfortunately, even though depression is very common and finding good treatments for depression are highly valued by patients on dialysis, there are only a few small studies to tell us about whether drug treatments are both safe and reduce symptoms. Based on this information, we still don't know whether depression treatment works well for people treated with dialysis and is safe (doesn't cause excess and serious side effects).

Quality of the evidence

The question of whether drugs can reduce symptoms of depression and improve quality of life for people on dialysis is still important. We need a big study that involves dialysis patients and assesses a commonly-used antidepressant drug with a placebo and measures the treatment effects based on what patients and their families value most.

Laički sažetak

Antidepresivi za liječenje depresije u odraslih osoba na dijalizi sa završnim stadijem zatajenja bubrega

Dosadašnje spoznaje

Osobe na dijalizi često pate od depresije i anksioznosti. Depresija je u tim situacijama povezana s lošom kvalitetom života i povećanim brojem komplikacija, kao što su liječenje u bolnici, ili prekid terapije dijalizom. Pacijenti, njihove obitelji i zdravstveni radnici svjesni su da je liječenje depresije na odgovarajući način i pronalaženje učinkovite terapije jako važno. Antidepresivi neće izaći iz tijela brzinom kojom bi se izlučili u osoba bez bubrežnih bolesti, što može uzrokovati još više nuspojava. Unatoč tome što je depresija vrlo česta i što terapije mogu potencijalno imati razne nuspojave, za razliku od ljudi bez zatajenja bubrega, prethodna verzija ovog Cochrane sustavnog pregleda koja je objavljena 2005. pronašla je samo jedan klinički pokus na tu temu. Nije poznato da li terapija antidepresivima zaista djeluje i da li je sigurna za osobe oboljele od bubrežnog zatajenja.

Cilj ovog Cochrane sustavnog pregleda literature bio je analizirati da li terapija antidepresivima djeluje i da li je sigurna kod osoba sa zatajenjem bubrega. Te informacije važne su za pacijente i njihove obitelji, zdravstvene radnike i donositelje odluka kako bi mogli oblikovati smjernice za liječenje.

Ovaj pregled literature nam daje uvid da li terapija antidepresivima poboljšava simptome u odraslih osoba na dijalizi bez uzrokovanja čestih i ozbiljnih nuspojava.

Obilježja studija

Uključili smo sva istraživanja koja su usporedila terapije antidepresivima s placebo liječenjem ili drugim vrstama mentalne potpore. Ispitanici su imali jednaku vjerojatnost da će biti razvrstani u bilo koju terapijsku skupinu.

Ključni rezultati

Nažalost, iako je depresija vrlo česta i pronalaženje odgovarajuće terapije za nju vrlo važno za pacijente koju su na dijalizi, postoji malen broj istraživanja koja ispituju da li je terapija antidepresivima sigurna i da li ublažuje simptome depresije. Na temelju tih informacija, mi i dalje ne znamo da li terapije za depresiju dobro djeluju za ljude na dijalizi i da li su sigurne (tj, da ne uzrokuje ozbiljne nuspojave).

Kvaliteta dokaza

Pitanje da li lijekovi smanjuju simptome depresije i poboljšavaju li kvalitetu života osoba na dijalizi je i dalje vrlo bitno. Potrebno je provesti veliko istraživanje koje će uključiti pacijente na dijalizi i istražiti djelovanje najčešće korištenih antidepresiva u usporedbi s placebom i koje će mjeriti posljedice terapije temeljem procjene pacijenata i njihovih obitelji.

Bilješke prijevoda

Hrvatski Cochrane
Prevela: Doris Kolovrat
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr