Effectiveness of Pharmacological Versus Non-pharmacological Methods for Managing Depression in Patients Undergoing Hospital Hemodialysis: A Narrative Review.

Depression is one of the most common mental health issues prevalent in end-stage renal disease (ESRD) patients requiring hemodialysis, yet there is limited evidence on the best approach to treat depression in hemodialysis patients. A narrative review was conducted to examine the effectiveness of both pharmacological and non-pharmacological interventions, including antidepressant medications, dietary and herbal supplements, cognitive behavioral therapy (CBT), psychotherapy, acupressure, and exercise regimens to alleviate depressive symptoms and improve the quality of life as evaluated by various depression and quality of life screening tools and questionnaires. A database search was conducted in the University of South Wales Library as well as the MEDLINE database, and relevant articles published in the English language and fitting the inclusion criteria, which mainly comprised articles assessing outcomes in terms of improvement in depression symptoms and quality of life, were selected for the purpose of this review. A total of 29 randomized controlled trials (RCT) were included in this review, of which eight studied pharmacological treatment methods and 21 studies examined non-pharmacological or psychosocial interventions to treat depression. The pharmacological interventions include antidepressant medications and supplements, compared with a placebo or another active intervention. Sertraline, as a selective serotonin reuptake inhibitor (SSRI) in hemodialysis patients, has conflicting evidence base, whereas there is inconclusive evidence for the effectiveness of fluoxetine and citalopram. The role of supplements is promising in this population cohort and needs further research to justify their use in treating depression. The non-pharmacological methods include CBT, guided imagery, psychotherapy, endurance-resistance training, exercise training, mindfulness-based stress reduction, acupressure, tele-nursing, Benson relaxation technique, hope therapy, and internet-based intervention. CBT is the most widely studied intervention and proves to be effective against wait-listed patients, but does not prove to have a more beneficial effect when compared to psychotherapy. Various exercise regimens, including endurance-resistance training and intra-dialysis exercise, show good results in alleviating depressive symptoms, but further research is required in this field to establish these methods as a treatment option in the future. Other interventions such as hope therapy, internet-based measures, guided imagery, tele-nursing, Benson relaxation technique, and mindfulness-based stress reduction all have very limited evidence, although they have been trialed in studies. This review combines both pharmacological and non-pharmacological treatment options and their effectiveness in treating depression in hemodialysis patients. Dietary and herbal supplements have low-grade evidence, whereas more research is required for SSRIs in treating depression. CBT is useful to improve depression scores and quality of life, along with psychotherapy. A standardized approach and follow-up of patients throughout the treatment and follow-up period, along with a greater sample size and assessment of outcomes through more standardized tools and questionnaires, would improve the quality of evidence collected, which will ultimately aid in establishing an evidence-based method of addressing an important health concern, that is, depression in hemodialysis patients.