Mental health and kidney disease

Being diagnosed with kidney disease can be overwhelming: not only do you suffer from physical fatigue, but kidney problems can also be emotionally and psychologically  draining. Some of the emotions you may experience include: frustration, despair, fear, a sense of lack of control and depression - especially if you require dialysis or a kidney transplant. This article focuses on the common psychological issues that someone with kidney disease faces and will introduce some of the treatments and coping mechanisms.

Depression in kidney patients 

Depression is a mental disorder characterised by chronic sadness, loss of interest in hobbies, sleep and appetite changes and feelings of worthlessness or emptiness. Depression is highly prevalent in patients with kidney disease. It has a 3 to 4 times higher prevalence rate  among kidney disease patients than the general population¹. It is also 2 to 3 times more commonly affecting patients with kidney disease than other chronic diseases, including diabetes, coronary artery disease, and chronic obstructive pulmonary disease.

Accordingly, the rate of antidepressant prescription is nearly 1.5 times higher in kidney disease patients than in the general population. The common factors that may contribute to depression in kidney disease patients include, but are not limited to: 

1. Regular pain and sleeping difficulties,
2. Unwanted feelings of dependence on health care providers and dialysis machines,
3. Feelings of powerlessness over the disease,
4. Inability to stand up to societal pressures at the expense of their own health care needs, such as failing to fulfil your role as a parent, sibling or employee, the illness interfering with social activities (for example, following a kidney-healthy diet interfering with eating with friends or family),
5. Feelings of hopelessness as there is ultimately no cure for kidney disease.

This, among other factors such as strict dietary and fluid restrictions, can greatly affect the patient's quality of life. Their depressive symptoms may only further affect both physical and emotional components of quality of life: low mood may cause a patient to not take proper care of themselves or neglect treatment, leading to a  higher risk of hospitalisation and death. 

There may be a biological element to kidney disease-related depression. Research has shown that kidney disorder can cause a decline in cognitive function, which means that certain chemical instruments of our mood regulation are released in amounts higher than usual. This is what leads to mood disorders in people with kidney issues². Moreover, a patient who is undergoing haemodialysis releases uremic toxins that can cause cognitive decline. 

Treatments for depression in kidney disease patients

Antidepressants

The first-line treatment considered for depression are antidepressants, more specifically selective serotonin reuptake inhibitors. They work by increasing the amount of serotonin, which stabilises happiness, in the brain. They can be prescribed for kidney disease patients, as they are metabolised by the liver, meaning that they are unlikely to be removed prematurely by dialysis or negatively affect the kidneys.

Talk-based Therapies 

Treatment-related depressive symptoms can also be managed through a non-pharmaceutical path. This may include psychotherapy such as cognitive behavioural therapy, as well as more lifestyle-based changes such as exercising and having a supportive social network. This can increase a patient’s engagement in physical activity and motivation as well as providing them with a safe environment to discuss their emotions, increase positive outlook and self-esteem. 

Anxiety in kidney patients 

Anxiety is also a common psychiatric condition in patients. However, this condition has been substantially less studied than depression. Still, research has shown that 46% of kidney disease patients suffer from the condition.

Anxiety symptoms may be associated with poor clinical and psychological outcomes like poor health-related quality of life, hospitalisation, and mortality. It is common to have good days and bad days throughout your kidney disease journey, some factors that may trigger anxiety include but are not limited to :

1. An onset of stress when you are less capable of carrying out daily tasks due to reduced kidney function, 
2. Progress to another stage of kidney disease, 
3. The commencement of treatment,
4. Anxiety relating to feeling dependant on those around you,
5. Feelings of lack of control over your schedule and life.

Treatment for anxiety in kidney disease patients

The first-line pharmacological strategy recommended to treat anxiety disorders in kidney patients is the use of selective serotonin reuptake inhibitors. Few recent studies have suggested that  cognitive-behavioral intervention methods consisting of positive self-reinforcement, deep breathing, muscle relaxation, and cognitive restructuring may help  in decreasing symptoms of both anxiety and depression^3,4.

Coping mechanisms for kidney disease patients

The human body is designed to handle regular day-to-day stress. However, kidney disease adds many more severe stressors than bodies are designed to endure.

These additional stressors can include financial worries related to your  inability to work, dietary constraints and other restrictions, as well as the illness itself. Because of these added burdens, kidney patients are at a much higher risk of suffering from depression than the general public.

These emotions might feel out of hand. You may often think of quitting the treatment or isolating yourself. Remember that it is okay to be angry, sad and scared or occasionally withdraw from social activities. But if these moments become too frequent, please bring it up with your doctor.

Here are a few initiatives that may help you feel better:

1. Light physical activity, such as a walk, alone or with a family member or a friend,
2. A healthy diet,
3. Joining support groups.