1. Depression while on Dialysis: What to look for and How to Deal with It
Samantha Mok, MSW, LSW
Kidney and Pancreas Social Worker
University of Illinois Health and Science System
Phone:
-11 years of solid organ transplant experience (heart/LVAD, liver, pancreas, kidney, living donors
-STL and CHI
-for past 4 years spent 90% of my time assessing depresion and other barriers for successful transplant

2. What is Depression?
Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
1. Depressed mood most of the day, nearly every day, or observation made by others
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
3. Significant weight loss when not dieting or weight gain
4. Insomnia or hypersomnia nearly every day.
-taken from DSMV--for adults only
-depressed mood means: sad, hopless, empty, tearful
-plus or minus 5% body weight in one month

3. What is Depression (cont.)
5. Psychomotor agitation or retardation nearly every day
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan for committing suicide.
-others should notice agitation or moving slowly, not only self report
-fatigue and no energy should exclude medical probs

4. How do we Assess Depression?
-PHQ-9
-Beck Depression Scale
LISTEN TO THE PATIENT!!!!!
-summarize scales

5. Dialysis and Depression
“Depression is the most important neuropsychiatric complication in chronic kidney disease...” -Teles et. al
-20-60% of hemodialysis patients have depression
- Do PD patients do better?
-Patients with less or controlled depression tend to do better medically
-dialysis pts self report depression, so number may be off--listen to the patient!!!!
-hd pts are more likely to be hospitalized for psych disorder than PD
-mixed reviews on whether pd pts do better than Hd patients per literature
-PD pts may do better in my experience. THey have more support
-pts with less dep have less hopitalizations, live longer, -

6. Depression and Dialysis
Common symptoms I see:
-Stop going to HD/PD
-Overeating/undereating
- Sleeping too much
-Drug and alcohol abuse
-Stop taking medications
-Guilt/feeling like a failure
expand over and undereat, sleep

7. How dialysis impacts your life?
-Body image concerns
-Not working/no money
-Isolation
-Strain on relationships
-Loss of “status”
-fistula, color, pd catheter
-caregiver/support burn out
-Bass C.

8. What do we do about it?
-Medicare mandates that all dialysis facilities have a master’s prepared licensed social worker
-Support system
-Medication
-Mental health services
-Shift change
-Education
-Transplant
-depression was higher in morning shift--only difference they lived further away. Race, age, employment status and sex was the same
-evening shift had slightly lower depression
-depressed pts hospitalized up to 5 time higher
-talk to other dialysis pts

9. Shannon
-Her story
-Clinical assessment
-Suicide attempts

10. Donovan
-His story
-Clinical assessment
-Guilt

11. Summary Depression is VERY common with people on dialysis.
Get help if you need it.
Substance Abuse and Mental Health Services Administration (SAMHSA)
-resources all staff, NKFI
-SAMSHA is nationwide, details adult, man, women, location, cost, insurance

12. QUESTIONS