Journal Article Annotations
2017, 1st Quarter
Annotations by Paula Zimbrean, MD, FAPM, and Marta Novak, MD, PhD
The finding: Sertraline showed no benefit over placebo in a randomized controlled trial for treatment of depression in hemodialysis patients.
Strengths and weaknesses: This is a randomized placebo-controlled trial designed to evaluate the efficacy of sertraline for treatment of depression in patients on dialysis. The design was prospective, multicentered; over 700 patients were screened for eligibility. The number of subjects, however, was rather low and the drop-out rate was high. There were significant differences in the drop outs in the sertraline group versus placebo group.
Relevance: Antidepressants are frequently used to treat depression in patients with CKD, including those on hemodialysis; however, there is no systematic data about their efficacy and tolerability. This is the first placebo-controlled trial of an antidepressant in this population. Although the power of the study is not sufficient to draw final conclusions about the efficacy of sertraline in this population, drop outs and side effects were more common in the sertraline group. For the clinician, these results invite caution before starting antidepressants in hemodialysis patients, careful consideration of alternative interventions, and a realistic discussion with patients about risks and benefits of treatment in this situation.