It is very common for people with Chronic Kidney Disease (CKD), especially those who reach End Stage Renal Disease (ESRD), to experience mental health disorders. Indeed, once ESRD is diagnosed, patients undergo a huge amount of stressors: they spend at least three days per week in a dialysis center or in a hospital for about four hours each session, they undergo dietary and lifestyle changes, they need to manage their daily trips to the dialysis unit besides considering possible family relocations and financial restrictions.
Although it is normal to experience sadness due to the several life-changes that kidney patients will encounter, a persistent very low mood combined with persistent negative thinking, lack of energy and motivation may be sign of depression, which is a medical condition that concerns between 22% and 39% of ESRD patients.
What is less obvious is how much depression may contribute to the progression of CKD: someone suffering from depression is more likely to embrace unhealthy habits such as tobacco use, harmful alcohol consumption, unhealthy diet and physical inactivity. These habits can lead to diabetes, hypertension or obesity; ultimately exposing patients to a higher risk of developing CKD.
Depression can therefore be both: a consequence of life on dialysis, but may also contribute to the root causes of CKD and kidney failure. The lack of self-care and energy that characterize depression have detrimental effects on patients’ capacity to deal with their disease. Furthermore, it is extremely difficult to expect from patients with pre-existent depression to make the required life-changes once diagnosed with reduced kidney function.
Depression is a real disease; it is not simply “being in a bad mood” or “needing motivation”. If you are a care-giver, keep in mind that no matter how much you love someone, you cannot fix their depressive disorders as much as you cannot heal them from CKD: both conditions require a medical assessment, diagnosis and treatment. Do not address a depressed patient with words such as “We all go through times like this” or “Look on the bright side”. You cannot encourage them to be happy. What you can do, instead, is encouraging them to seek help.
If you are a kidney patient with several symptoms of depression, you need to realize that the latter is not less of a disease than the former. You may need a psychiatrist/psychologist as much as you need your nephrologist. Seek help by talking to a doctor about your condition and you will soon learn that – like any other disease – your symptoms will be assessed, you will receive a diagnosis and, based on this, you will receive a treatment.
In a nutshell, do not underestimate any mental disorder, especially depression. Having another severe health issue, such as CKD, should not overshadow the importance of your mental health. Healing from depression is absolutely possible if you ask for help, making you feel in tune with your life, with or without dialysis.
We highly recommend you to watch the video released by the WHO on Depression. If you recognize yourself in that pattern, please refer to your doctor as soon as possible.
Written by Tara Riva
 Articles, M. (2019). Kidney International Reports. [online] Journals.elsevier.com. Available at: https://www.journals.elsevier.com/kidney-international-reports/most-cited-articles [Accessed 23 May 2019].
 Ibidem; see also Depression: the overlooked complication of kidney disease. [online] Available at: http://www.kidneyfund.org/training/webinars/depression-and-kidney-disease.html [Accessed 27 May 2019].
 Kidney Care UK. (2019). Mental health. [online] Available at: https://www.kidneycareuk.org/about-kidney-health/living-kidney-disease/mental-health/ [Accessed 23 May 2019].
 Articles, M. (2019). Kidney International Reports.
 YouTube. (2019). I had a black dog, his name was depression. [online] Available at: https://www.youtube.com/watch?v=XiCrniLQGYc [Accessed 28 May 2019].