Journal Article Annotations
2020, 2nd Quarter
Annotations by Sahil Munjal, MD and Sarah Andrews, MD
June 24, 2020
PUBLICATION #1 — Psychonephrology
This case series of four patients (part of a larger study) with MDD on HD is the first study to describe observed treatment with weekly fluoxetine at dosages beyond 90mg/week. All patients received the 180mg dose which was lowered to 90mg in two patients due to tolerability. All patients achieved remission.
Strength and weaknesses
Diagnosis of MDD in patients with baseline PHQ9 scores of 10 was confirmed by MINI and clinical assessment by the mental health nurse practitioner. Nevertheless this was a small case series of four patients. All were female, and there is a possibility of gender differences in fluoxetine metabolism. The report is of a short time frame of 12 weeks.
Approximately a third of HD patients have MDD which is associated with poor outcomes. This study highlights the advantages of weekly fluoxetine including decreased pill burden, increased adherence, and no requirement of dose adjustments in kidney failure patients. This study also makes a case for directly observed medication administration given the high rate of medication nonadherence in this population even as patients attend dialysis treatment three times weekly. 90mg weekly fluoxetine was well tolerated but patients with partial response may benefit from a higher dose (180mg) due to individual differences in fluoxetine metabolism. Common side effects included restlessness, dry mouth, sedation, and lightheadedness which may limit tolerance of the 180 mg dose in some individuals.
Type of study
PUBLICATION #2 — Psychonephrology
Depression is one of the most common psychiatric disorders among patients with kidney failure. Depression can lead to significant complications in renal failure including decreased quality of life, increased hospitalization rates, and increased mortality. This study focused how patients undergoing hemodialysis and peritoneal dialysis experience psychological issues as evaluated through semi-structured interviews. The major themes identified in these population included depression, anxiety, burnout, despair, and decreased social supports. Patients identified that their negative psychological impact occurred even prior to starting dialysis, specifically at the time of losing kidney function.
Strengths and weaknesses
This study completed in-depth interviews using semi-structured questions with 20 patients. The narratives provided in this study are powerful descriptions about their experiences with kidney failure and dialysis. This study identified several themes that are vital to address with patients. Although this study identify themes patients discussed in their semi-structured interviews, including depression and anxiety, there were no structured scales or further evaluation to determine if these patients suffered from an affective or anxiety disorder.
Consult-liaison psychiatrists are often consulted on patients suffering from depression and anxiety. In the dialysis population, even though patients may not meet criteria for an affective or anxiety disorder, there are still struggles they experience that decrease quality of life and negatively impact psychological well-being.
Type of study