Depression in patients with end-stage renal disease: psychopathology or normative response?

Depressive symptoms may arise as part of the normative response to the onset or progression of serious medical illness such as end-stage renal disease (ESRD). However, persistent and severe depressive symptoms are not usual in such patients and may indicate the need for a clinical intervention, whether or not a psychiatric disorder is present. Patients with more severe medical illness, a prior history of depression, and low social support are at risk to develop the syndrome of major depression. Problems in diagnosing this disorder in ESRD are discussed. Accurate diagnosis is important because of the availability of effective antidepressant treatments. However, interventions may also be indicated as prevention or treatment for patients with subthreshold depressive symptoms.