Depression is common among those with Chronic Kidney Disease, with up to 40 percent of CKD patients experiencing it. Statistics show that up to 50 percent of hemodialysis patients experience depression. Symptoms include:
- A loss of interest in activities they once enjoyed
- A depressed mood, feeling of sadness, helplessness, hopelessness and crying
- Sleep pattern changes: sleeping too much, waking up in the middle of the night or being unable to get restful sleep
- Inability to concentrate
- Appetite changes: an increased or decreased appetite with weight gain or weight loss
- Being restless, easily annoyed or irritable
- Increased fatigue
- Low self-esteem-feelings of worthlessness and excessive guilt
- Reduced interest in sexual activity
- Thoughts of harming self or thoughts of death
Some mental health professionals use the concept of "demoralization" to distinguish between depressive disorders and sorrows that are part of the human condition. This is a very important distinction that people suffering emotional turmoil should keep in mind before accepting a diagnosis of major depressive disorder and particularly before turning to antidepressant medications to ease their emotional pain.
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A diagnosis of major depressive disorder requires that a person has experienced either a depressed mood or the loss of interest or pleasure in most activities and four additional symptoms such as thoughts of death or suicide or changes in appetite, sleep, or activity, for at least two weeks. Minor depression has fewer and less severe symptoms. A depressed mood that lasts two years or longer is called Dysthymia. Adjustment disorders are reactions to a distressing event, such as a serious physical illness that is in excess of what would be expected and/or involves significant impairment in functioning such as Chronic Kidney Disease. In contrast, "demoralization" is generally defined as persistent inability to cope.
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Although demoralization can occur in response to many distressing circumstances including long-term unemployment, displacement due to war or a natural disaster, imprisonment, etc., much of the literature about demoralization focuses on people who have a terminal or severely disabling physical illness or injury and are extremely distressed about it.
Thinking that you will die sooner than expected, or that that you will have to live with severe pain either for the short term or for many years can evoke powerful, emotionally-charged questions. Did I do enough with my life? Have I provided for my children? Has my life had meaning? What will I be after I die? Facing questions like these can be terribly upsetting and evoke or reflect a state of demoralization.
Truth be told, distinguishing between depression and demoralization can be difficult. It requires consideration of how severe the symptoms are, whether they are an understandable reaction to troubling circumstances or are excessive, and whether there is a history of mental illness prior to the current situation. Even professionals sometimes disagree. Mental health professionals also don't agree about whether demoralization should be regarded as a specific diagnosable mood disorder.
Nevertheless, the distinction between major depressive disorder and demoralization is important, and it matters which diagnosis is made, if only because most of us don't want to be diagnosed with a disease we don't actually have, whether it's depression or diabetes.
In addition, characterizing a person's emotional pain as major depression or as demoralization influences the choice of intervention. A diagnosis of a major depressive disorder tilts us in the direction of prescribing antidepressant medications, which are not more effective than placebos except for people with a severe major depressive disorder.
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Characterizing a person as demoralized may lead to more appropriate, non-pharmacological interventions such as engaging in satisfying and meaningful activities, maintaining caring relationships, spiritual counseling, meditation, life review, physical exercise to the extent possible, and, very importantly, psychotherapy. Seeking this type of therapy can be helpful for some people struggling with sorrows that are part of the human condition, whether or not they constitute a diagnosable mental disorder.
A full professional workup can help to differentiate demoralization from a major depressive disorder. Troubling moods can arise from a variety of contexts. They may indicate a major mental disorder, but could also represent reactions to life circumstance, personality vulnerabilities, or patterns of behavior. The handling of the sadness must match its source. So, those of you who may be caught up in your human troubles and are "depressed," it can be important to ask yourself whether you are clinically depressed or demoralized.
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Chronic Kidney Disease can bring on bouts of "depression" and can lead to a rundown physical condition that can interfere with successful treatment of Chronic Kidney Disease. Management of the disease, and demoralization or depression, can be accomplished by consulting your social worker who is an integral part of the Nephrology team.
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Reference: Friedman, L.M.S.W., Michael. "Depressed or Demoralized?" The Huffington Post.