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Annals of Internal Medicine SUMMARIES FOR PATIENTS

Comparing the Effectiveness of Depression Treatments for


Patients Undergoing Maintenance Hemodialysis
From: Mehrotra R, Cukor D, What is the problem and what is known about it so far?
Unruh M, Rue T, Heagerty P, Depression is a common problem that has many effective treatments, including cognitive
Cohen SD, et al. behavioral therapy (CBT) (a form of talk therapy that helps patients learn problem-solving
skills and behavioral modification strategies) and antidepressant medicines. About one
Comparative efficacy of third of patients with end-stage renal disease who are undergoing maintenance dialysis
therapies for treatment of have depression, but most of them do not receive treatment for it.
depression for patients
Why did the researchers do this particular study?
undergoing maintenance
The study had 2 purposes. First, the researchers wanted to see whether patients would
hemodialysis. A randomized be more willing to accept a diagnosis of depression, as well as treatment for it, if they first
clinical trial. Ann Intern Med. had a discussion with a therapist about the condition and options for treating it. Second,
2019;170:369-79. they wanted to compare the effects of CBT and sertraline (an antidepressant medicine) in
depressed patients receiving maintenance dialysis.
doi:10.7326/M18-2229
This article was published at Who was studied?
Patients older than 21 years with end-stage renal disease and major depression or dysthymia
Annals.org on 26 February
who were receiving maintenance dialysis at 1 of 41 dialysis facilities in Dallas, Texas;
2019. Albuquerque, New Mexico; or Seattle, Washington. Of 184 people who participated in part 1
of the trial (the interview), 120 continued on to part 2 (treatment comparison).
How was the study done?
Patients having hemodialysis were screened for depression, and those with a result
indicating major depression or dysthymia were invited to participate in the trial. The
patients who agreed to take part were randomly assigned to an intervention or a control
interview, which took place while they were receiving hemodialysis. During the
intervention interview, trained therapists discussed depression and its treatment with the
patients and helped ease their concerns about their diagnosis and therapy options.
During the control interview, patients talked with a member of the research team about
depression and were told about treatment options outside the study. After the
interviews, patients in both groups were asked if they wanted to participate in the second
half of the study. Those who agreed were randomly assigned to receive either CBT or
sertraline. Members of the CBT group had 10 one-hour sessions with a trained therapist
over 12 weeks while they received hemodialysis. Those in the sertraline group were
prescribed a dosage of 25 mg per day to start. It was increased gradually to a stable
dosage over 6 weeks, which was maintained for another 6 weeks. Patients in both groups
completed questionnaires to measure depression symptoms at baseline and at 6 and 12
weeks. The researchers measured the proportion (or rate) of patients who decided to
start depression treatment after they completed the first interview (intervention or
control). They then compared the difference in depression scores at 12 weeks between
the CBT and sertraline groups.
What did the researchers find?
After comparing the group interviewed by a therapist with the group that received only
Summaries for Patients are a
general information about depression, the researchers found no difference in the
service provided by Annals to proportion of patients who agreed to start depression treatment. Although depression
help patients better scores improved in both the CBT and sertraline groups, improvement was slightly
understand the complicated greater among the patients who received sertraline. However, side effects were more
and often mystifying language frequent in the sertraline than in the CBT group.
of modern medicine. What were the limitations of the study?
The study did not include a group of patients randomly assigned to receive no treatment.
Summaries for Patients are presented
for informational purposes only. These What are the implications of the study?
summaries are not a substitute for ad- For patients receiving dialysis, an interview with a therapist had no effect on their
vice from your own medical provider. If willingness to start depression treatment. Although patients who received sertraline had
you have questions about this material,
or need medical advice about your slightly more improvement in their depression scores than those who had CBT, they also
own health or situation, please contact had more side effects.
your physician. The summaries may be
reproduced for not-for-profit educa-
tional purposes only. Any other uses
must be approved by the American
College of Physicians. Ann Intern Med. 2019;170:I-18. doi:10.7326/P19-0001

I-18 © 2019 American College of Physicians

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