Professional Treatment Options

Psychotherapy

Psychotherapy is a method of talking in person with a therapist. Here are a few types of therapy available:

• Behavior therapy – Includes stress management, biofeedback and relaxation training in order to change thinking patterns and behavior.
• Psychoanalysis – Long term therapy to recognize unconscious thoughts and early patterns to resolve issues and become aware of how those issue influences your actions and feelings.
• Cognitive therapy – Identifies and corrects thinking patterns that can lead to troublesome feelings and behavior.
• Family therapy – Includes discussions and problem solving skills with members of your family.
• Group therapy – Includes a small group of people to discuss individual issues in a group setting in order to help each other with their problems.

Types of Mental Health Professionals[1]:

If you decide you would like to seek help from a professional, talk with your medical team about which one may be right for you. Below are some professionals that specialize in mental health counseling:

• Psychiatrist – medical doctor who specializes in the diagnosis and treatment of mental disorders. These doctors are allowed to prescribe medication.
• Child/Adolescent Psychiatrist – medical doctor who specializes in the diagnoses and treatment of emotional and behavioral problems in children. These doctors are allowed to prescribe medications.
• Psychologist – A psychologist has a doctoral degree in psychology. These doctors specialize in diagnoses and are able to provide individual and group therapy. However, a psychologist cannot prescribe medication.
• Clinical Social Worker – a counselor with a master’s degree in social work. These counselors are trained to make diagnoses and provide individual and group therapy. A clinical social worker cannot prescribe medication.
• Mental Health Counselor – a counselor with a master’s degree and several years of clinical work experience. Trained to diagnose and provide individual and group therapies.

Medication Therapy

Medications can be helpful to people with a diagnosed mental or emotional health disorder. If medications are prescribed, it is important that you talk with your doctor to learn about possible side effects or drug interaction with your kidney disease or other medications.

There are several types of drugs available to treat mental conditions. There are anti-depressants, anti-anxiety, and anti-psychotic medications.

Depression

Dialysis and depression are commonly linked. As we talked about earlier, learning that you have kidney disease or kidney failure is a trying situation. Many patients have difficulty coping with the news or lack a proper support structure. Devon Osborne, a DPC Patient Ambassador, shared his story in a recent article for Renal Business Today. The article can be found here http://www.renalbusiness.com/blogs/experts-eyes/2012/09/dialysis-and-depression-a-patients-perspective.aspx.

Antidepressants are medications that treat depression by balancing the natural chemicals like serotonin and dopamine in your brain.

The most commonly prescribed anti-depressants are called selective serotonin reuptake inhibitors (SSRI). This is a process in which neurotransmitters (the chemicals responsible for good and bad feelings) in your brain are absorbed back into nerve cells. A reuptake inhibitor prevents this from happening. So instead of getting reabsorbed, the neurotransmitter stays longer in the gap between the nerves allowing for better communication between the nerve cells.  

In the case of depression, neurotransmitters such as serotonin are lacking and therefore they can’t send out the next message. If you take a selective serotonin reuptake inhibitor or a serotonin norepinephrine reuptake inhibitor (SNRI) it will slow down the process of returning the chemical to the end of the neuron. In turn, this will boosts your mood because it will change the balance of your serotonin levels.[2] Both types are very popular these days because they have fewer side effects than older classes of medications.

The several main neurotransmitters:

• Dopamine – helps control motivation and voluntary movement, emotional responses and the ability to feel pain and pleasure
• Epinephrine – also known as adrenaline and is stimulated during the flight or fight response that happens when you are startled or threatened
• Glutamate – is an excitatory neurotransmitter and it is required for learning and memory
• Norepinephrine – is also excitatory and helps control stress, blood pressure and general activity
• Serotonin – plays a role in mood fluctuations, anxiety and arousal

Common SSRI drugs and their side effects:

• Prozac – Nausea, agitation, insomnia, drowsiness, tremor, dry mouth, dizziness, headache, sweating, weakness, anxiety, weight gain or loss, sexual dysfunction, runny nose, muscle plain, rash. [3]
• Zoloft - Nausea, agitation, insomnia, drowsiness, tremor, dry mouth, dizziness, headache, sweating, weakness, anxiety, weight gain or loss, sexual dysfunction, runny nose, muscle plain, rash. [4]
• Lexapro - Nausea, agitation, insomnia, drowsiness, tremor, dry mouth, dizziness, headache, sweating, weakness, anxiety, weight gain or loss, sexual dysfunction, runny nose, muscle plain, rash.[5]

Common SNRI drugs and their side effects:

• Effexor – Nausea, vomiting, anorexia, headache, sweating, rash, anxiety, dizziness, fatigue, hypertension, tremors. [6]
• Cymbalta – Nausea, dry mouth, constipation, decreased appetite, sweating, sweating, insomnia, sleepiness, tiredness, blurred vision, tremors. [7]
• Pristiq – Nausea, loss of appetite, insomnia, dizziness, dry mouth, headache, weakness, sweating, high blood pressure, pupil dilation.[8]

As with any medicine, there will be side effects. Side effects differ from medication to medication and from person to person. If you are prescribed any medicine, alert your doctor immediately if you have a reaction. It is also important that you take the medication as prescribed and don’t stop if you start to feel better. Talk with your doctor and they will determine if you need to continue with your medication.

Anxiety Disorders

Antianxiety and antidepressant medications are used to treat many types of anxiety disorders. In some instances medications knows as beta blockers are also given.

The most commonly diagnosed anxiety disorders are:

• Generalized anxiety disorder (GAD)
• Obsessive compulsive disorder (OCD)
• Panic disorders
• Post-traumatic stress disorder (PTSD)
• Social phobias

Since dealing with a chronic condition can be stressful there is an increased risk to develop an anxiety disorder.  Many of the above antidepressants are also useful for anxiety disorders. Prozac, Zoloft and Laxapro are commonly described for panic disorders. Paxil and Celexa can be used for OCT, PTSD and social phobias as well.[9]

 Benzodiazepines are a group of medications that have a sedative (calming) effect. This means that it calms your body down by slowing down the brain activity to reduce anxiety.

Benzodiazepines and their side effects:

• Valium – Drowsiness, dizziness, loss of memory, headache, hangover feeling in the morning, slurred speech, unpleasant dreams.[10]
• Xanax – Drowsiness, dizziness, clumsiness, slurred speech, loss of appetite, gastrointestinal problems, headache, blurred vision, change in sex drive.[11]
• Ativan – Drowsiness, dizziness, sleepiness, clumsiness, weakness, loss of memory. [12]

Beta-blockers can help control some of the symptoms of anxiety such as sweating and trembling. Controlling the physical signs associated with anxiety can help reduce anxiety. For example, if giving a speech makes you anxious the beta-blocker can help mask some of your symptoms and give you the confidence to face the audience.

General side effects include:

• Cold hands
• Dizziness
• Fatigue
• Weakness

Please note that beta-blockers are not recommended for those with diabetes as it can worsen the symptoms.

Psychotic Disorders[13]:

This is a group of disorders that cause you to have abnormal thinking or cause you to perceive the world in a non-normal way. People that suffer with psychotic disorders often report, seeing, hearing or feeling that something or someone is there or watching them. The disease could also cause them to believe that a TV character is out to get them.

Common illnesses are:

• Schizophrenia
• General delusional disorder
• Schizophrniform disorder
• Shared psychotic disorders

These medications are commonly used to treat psychotic disorders and sometimes mood disorders such a bipolar disorder or major depression.

• Chlorpromazine (Thorazine)
• Haloperidol (Haldol)
• Perphenazine (generic only)
• Fluphenazine (generic only)

The drugs listed above are from the older generation of drugs developed in the 1950s. In the 90’s new drugs were developed and the one most commonly prescribed is clozapine (Clozaril). Although clozapine has been a very effective medication, it has been known to cause agranulocytosis, which is a condition that impacts white blood cell production. White blood cells are the main defenders in your body that help you fight infections.

Other newer generation drugs were developed and don’t cause agranulocytosis.

These include:

• Risperidone (Risperdal)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Ziprasidone (Geodon)
• Aripiprazole (Abilify)
• Paliperidone (Invega)

Like the other medications, there are side effects.

• Drowsiness
• Dizziness when changing positions
• Blurred vision
• Rapid heartbeat
• Sensitivity to the sun
• Skin rashes
• Menstrual problems for women

Additional warnings can include changes in metabolism and weight gain. Patients with conditions such as diabetes should be extra careful if prescribed an antipsychotic medication. Additionally, antipsychotics are known to have other drug interactions. It is important to share any over the counter or other prescription medications that you currently take. Your doctor will understand these issues, but it is still important to point out your condition to your medical team.  

Drug interactions:

It is important for you to remember that any drug you take can have an adverse effect with other drugs that you may be taking. A drug interaction is a reaction caused by a combination of drugs that can potentially cause harmful side effects to the person who is taking the drug. Be sure that the professional that prescribes your medication is aware of your kidney disease and every drug that you take for this and any other health problems. With any drug there is a possibility that they will interact with your current medicine. Your medical team will work with your pharmacist to make sure there isn’t an issue.