Depression Treatment in Dialysis Patients—Randomized Trial

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Both sertraline and cognitive-behavioral therapy (CBT) improve depression symptoms in hemodialysis patients, but an engagement interview does not increase patient acceptance of depression therapy, reports a two-phase trial in Annals of Internal Medicine.

The open-label, randomized trial included 184 maintenance dialysis patients at 31 facilities in three US metropolitan areas. All had been receiving dialysis for at least 3 months and scored 15 or higher on the Beck Depression Inventory-II (BD-II). In an initial sample of nearly 2600 patients completing the BD-II, about one-fourth scored 15 or higher.

In the first phase of the study, patients were assigned to undergo an engagement interview or a control visit. Interviews were conducted by trained therapists, with the goals of increasing patients’ willingness to accept the diagnosis of depression and engage in treatment. In phase two, 120 patients were assigned to 12 weeks of CBT, conducted by therapists during outpatient hemodialysis; or treatment with sertraline, with a target dose of 200 mg.

In phase 1, the engagement interview did not significantly affect patient acceptance of depression therapy. In both groups, about two-thirds of patients initiated treatment within 28 days.

In phase 2, both treatments were associated with improvement on the Quick Inventory of Depressive Symptoms scale: from 12.2 to 8.1 with CBT and from 10.9 to 5.9 with sertraline. The response to sertraline was greater, with an estimated effect of −1.84. Mild to moderate adverse events were more frequent with sertraline.

Depression is common among dialysis patients, but most patients do not receive therapy. The new study is the first multicenter clinical trial of treatment for depression in maintenance hemodialysis patients.

The results suggest that an engagement interview does not increase patient acceptance of treatment [Mehrotra R, et al. Comparative efficacy of therapies for treatment of depression for patients undergoing maintenance hemodialysis: a randomized clinical trial. Ann Intern Med 2019; DOI: 10.7326/M18-2229].