Ayman Guirguis1,2, Joseph Chilcot3, Michael Almond4, Andrew Davenport5, David Wellsted1, Ken Farrington1,6. 1. Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, UK. 2. John Hampden Unit, Oxford Health NHS Foundation Trust, Psychiatric Liaison Service, Stoke Mandeville Hospital, Aylesbury, UK. 3. Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK. 4. School of Education and Social Care, Anglia Ruskin University, Chelmsford, UK. 5. UCL Centre for Nephrology, Royal Free Hospital NHS Foundation Trust, London, UK. 6. Renal Unit, Lister Hospital, East & North Hertfordshire NHS Trust, Stevenage, UK.
Abstract
BACKGROUND: Depression is common in patients on haemodialysis and associated with adverse outcomes. Antidepressant use is widespread though evidence of efficacy is limited. OBJECTIVES: To study antidepressant management practices in patients on haemodialysis with reference to NICE guidelines on management of depression in adults with chronic physical health problems. DESIGN: Prospective, multicentre, longitudinal cohort study with 6-15 month follow-up. PARTICIPANTS: Patients on haemodialysis established on antidepressant medication. MEASUREMENTS: Baseline assessment of mood was undertaken using Beck Depression Inventory (BDI-II). Demographic, clinical and medication data were also collected. Changes in clinical and life circumstances and medication during follow-up were recorded. At follow-up, BDI-II was reassessed and diagnostic psychiatric assessment undertaken. RESULTS: Forty-one patients were studied. General practitioners were the main prescribers (68%). Ten agents were in use, the commonest being Citalopram (39%). Doses were often suboptimal. At baseline, 30 patients had high BDI-II scores (≥16) and 22 remained high at follow-up. Eleven had BDI-II < 16 at baseline. In five, this increased on follow-up to ≥16. Sixteen patients (39%) had no medication review during follow-up, 14 (34%) had a dose review, and 11 (27%) a medication change. On psychiatric assessment at follow-up, eight patients had current major depressive disorder (MDD), seven recurrent and 20 evidence of past MDD. Six displayed no evidence of ever having MDD. CONCLUSIONS: Antidepressant management in patients on haemodialysis reflected poor drug selection, overprescription, under-dosing and inadequate follow-up suggesting sub-optimal adherence to NICE guidelines. Most patients had high depression scores at follow-up. Antidepressant use in haemodialysis requires reappraisal.
BACKGROUND:Depression is common in patients on haemodialysis and associated with adverse outcomes. Antidepressant use is widespread though evidence of efficacy is limited. OBJECTIVES: To study antidepressant management practices in patients on haemodialysis with reference to NICE guidelines on management of depression in adults with chronic physical health problems. DESIGN: Prospective, multicentre, longitudinal cohort study with 6-15 month follow-up. PARTICIPANTS: Patients on haemodialysis established on antidepressant medication. MEASUREMENTS: Baseline assessment of mood was undertaken using Beck Depression Inventory (BDI-II). Demographic, clinical and medication data were also collected. Changes in clinical and life circumstances and medication during follow-up were recorded. At follow-up, BDI-II was reassessed and diagnostic psychiatric assessment undertaken. RESULTS: Forty-one patients were studied. General practitioners were the main prescribers (68%). Ten agents were in use, the commonest being Citalopram (39%). Doses were often suboptimal. At baseline, 30 patients had high BDI-II scores (≥16) and 22 remained high at follow-up. Eleven had BDI-II < 16 at baseline. In five, this increased on follow-up to ≥16. Sixteen patients (39%) had no medication review during follow-up, 14 (34%) had a dose review, and 11 (27%) a medication change. On psychiatric assessment at follow-up, eight patients had current major depressive disorder (MDD), seven recurrent and 20 evidence of past MDD. Six displayed no evidence of ever having MDD. CONCLUSIONS: Antidepressant management in patients on haemodialysis reflected poor drug selection, overprescription, under-dosing and inadequate follow-up suggesting sub-optimal adherence to NICE guidelines. Most patients had high depression scores at follow-up. Antidepressant use in haemodialysis requires reappraisal.
Authors: Manon J M van Oosten; Dan Koning; Susan J J Logtenberg; Martijn J H Leegte; Henk J G Bilo; Marc H Hemmelder; Kitty J Jager; Vianda S Stel Journal: Clin Kidney J Date: 2021-12-03
Authors: Kara Schick-Makaroff; Charlotte Berendonk; Jordan Overwater; Laura Streith; Loretta Lee; Manuel Escoto; Daniel Cukor; Scott Klarenbach; Richard Sawatzky Journal: Can J Kidney Health Dis Date: 2022-08-23