Mental health and kidney disease

What is mental health?

Mental health is your emotional, psychological, and social well-being. Good mental health helps you handle stress, make decisions and build healthy relationships. Depression and anxiety are two of the most common mental health conditions that those living with kidney disease face. 

Depression can make you feel sad, hopeless or lose interest in things you enjoy. Anxiety can cause worry, tension or physical symptoms like a racing heart or trouble sleeping. 

Living with kidney disease affects more than just your body, it can impact your mental health, including your thoughts, emotions and relationships. Whether you have chronic kidney disease (CKD), are on dialysis or have had a transplant, it's normal to face emotional challenges. Remember, you are not alone and there are  resources  to support you through every step.

How does kidney disease affect mental health?

Maintaining good mental health can be a struggle for anyone, but it can be even harder if you have kidney disease. Depending on your stage of kidney disease, you may face added stressors in your life that impact your mental health. You may feel like there are so many things that you are being asked to change at once, which can feel overwhelming. The more advanced your kidney disease becomes, the more likely you are to experience an impact on your mental health. 

Depression, anxiety and dialysis

50% of the people on dialysis experience depression, anxiety or both. 

These conditions can cause:

• Trouble with memory
• Low energy
• Problems focusing
• Confusion or feeling "foggy"

If you are on dialysis, you may experience additional stress from:

• Financial burden of dialysis
• Time commitment for dialysis from in-center or at-home appointments
• Feeling like a burden to others
• Fear of pain or side effects from dialysis
• Unable to have restful sleep
• Changes in employment or reduced work hours
• Eating and fluid restrictions
• Worrying about dialysis impacting your family, work, social and love life. 

If you have kidney disease but are not yet on dialysis common stressors can include:

• Adjusting to dietary and lifestyle changes
• Managing multiple medicines
• Worrying about kidney disease progression
• Balancing medical appointments with work and family life

Depression

Depression is a common mental health condition that goes beyond occasional sadness. It can cause ongoing feelings of hopelessness or emptiness and make it hard to enjoy activities you once liked. Depression is not something you can just "snap out" of. Many people with kidney disease experience depression, but it can be hard to tell the difference between depression symptoms and the effects of kidney disease itself.

For example:

• Fatigue may be from anemia (low blood counts) or from depression.
• Sleep problems can be caused by kidney disease, dialysis schedules or depression.
• Changes in appetite may come from your treatment plan or from a low mood.

Because the symptoms of kidney disease and depression can overlap, depression sometimes goes unrecognized. That is why it's important to talk openly with your care team about how you're feeling, both physically and emotionally.

Possible symptoms of depression include:

• Feeling down or hopeless most of the day
• Losing interest in activities you used to enjoy
• Changes in appetite or major weight changes (eating too much or too little)
• Trouble sleeping (too little or too much)
• Feeling very tired or low in energy
• Moving or thinking more slowly than usual
• Trouble focusing or making decisions
• Feeling worthless or guilty
• Thoughts of harming yourself
• Thoughts of death or suicide

If you are having thoughts of suicide, call or text 988 right away to connect with the Suicide & Crisis Lifeline or visit them online and talk to someone immediately.

What you can do:

Depression is treatable. Counseling, support groups and medicine can all make a difference. Tell your doctor or nurse if you have any of these symptoms, even if you're not sure if they are from kidney disease or depression. 

It is normal to feel sad due to the life-changing experiences that happen when living with kidney disease. Depression doesn't look the same for everyone. But you should talk to your health care team (including your doctor, nurse or social worker) if you experience five or more symptoms for two weeks or longer or if these feelings or thoughts interfere with your day-to-day life.

Depression can sometimes lead to thoughts of hurting yourself or feeling like life is not worth living. If you ever have these thoughts, know that you are not alone and help is available.

• Call or text 988 to connect with the Suicide & Crisis Lifeline. You will be connected to free confidential support available 24 hours a day, 7 days a week.
• Call 911 right away if you feel like you might act on these thoughts or if you are in danger of harming yourself or others.
• Talk to someone you trust. This could be a friend, family member or member of your care team.

Reaching out for help is a sign of strength. Support is always available.

Confusion and brain fog

Many people with advanced kidney disease also experience confusion, memory problems or difficulty concentrating. This is sometimes called brain fog. Some people on dialysis may notice confusion or memory issues, often linked to changes in fluid balance and the makeup of their blood during treatment.

Confusion or brain fog can show up in different ways:

• Trouble focusing or paying attention
• Feeling disoriented or not thinking as clearly
• Memory problems
• Difficulty making decisions
• Sudden changes in mood or alertness

Substance abuse and mental health 

Some people may use substances like drugs or alcohol to cope with stress, sadness, difficult emotions or even physical problems, like pain. Misusing substances can cause serious harm, especially when you're managing kidney disease.

Alcohol's impact on kidney disease

Alcohol makes your kidneys work harder. Heavy drinking weakens their ability to filter waste and keep your body's fluids balanced. Over time, this can increase the risk of further kidney damage.

Alcohol: 

• Raises blood pressure and risk of injury: Alcohol can increase blood pressure and over time, raises your chance of kidney damage.
• Causes dehydration: Alcohol acts as a diuretic, which can lead to dehydration and strain your kidneys more.
• Can indirectly harm your kidneys through liver damage: Damage to the liver makes the kidneys work harder and can trigger further injury.

Alcohol may also interfere with medicines used for diabetes, heart health or high blood pressure, which are common in people with CKD. These interactions can make medicines less effective or increase side effects. This can be dangerous for both your physical and emotional health.

Pain medicine abuse

If you are on dialysis, your doctor may prescribe pain medicines (opioids) to treat your pain. While these medicines can be helpful, they are also very addictive. Misuse of opioids has led to a nationwide opioid crisis, affecting millions of people and their families. Opioids alter how your body handles sodium and water. This can lead to urinary retention, where you can't fully empty your bladder. Over time, this can cause acute kidney injury. If you are living with kidney disease, it is especially important to use opioids carefully and only as your doctor prescribes.

Marijuana

Some people with kidney disease use marijuana to cope with symptoms like pain, nausea, poor appetite, trouble sleeping or anxiety.  It's important to note that marijuana can interact with certain medicines and worsen mental health conditions like anxiety and depression. Because every person's situation is different, it's important to talk with your care team about using marijuana.
 

Illegal drugs and kidney health

Using illegal or recreational drugs can also harm your kidneys and overall health. Some illegal drugs can cut blood flow to the kidneys, trigger sudden kidney failure or raise blood pressure. Even occasional use can be risky, especially if you already have kidney disease. The Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline is a free, confidential, 24/7, 365-day-a-year, treatment referral and information service for people and their loved ones facing substance use and mental disorders. Visit the website or call the toll-free line for more information. Learn more

Your body and mind work together. Protecting yourself from harmful substances and taking steps to support your mental health can make it easier to handle stress and follow your treatment plan. 

Why it is important take care of your mental health

Taking care of your mental health is just as important as caring for your physical health. If you were to break a bone, you would see a doctor. But when it comes to stress, sadness or other emotional struggles, many people hesitate to ask for help.

Attitudes about mental health can differ across families, communities and cultures. Sometimes negative beliefs or stigma get in the way. Stigma happens when people are judged or labeled because of a health condition. This can make it harder to reach out, even when support is available.

How to get professional help

There is no shame in asking for help. The good news is you are not alone. There are people and resources available to help you cope in healthy ways.

Talk to your social worker

Social workers can provide strategies to help you manage the challenges you are facing. If your dialysis clinic has a social worker, they are people you can turn to when you are struggling with mental health. Social workers are there to help you and communicate your mental health needs with your doctor.

Getting support from a mental health professional can make a big difference in how you feel and how you manage kidney disease. The right treatment depends on your needs and how serious your symptoms are.

There are two main types of treatment:

• Therapy (counseling): Talking with a trained professional about your feelings, thoughts and behaviors. Therapy can help you cope with stress, depression, anxiety and substance use.
  • Cognitive behavioral therapy (CBT) is one of the most effective types. CBT teaches you skills to change negative thought patterns and improve your mood.
  • You can attend in-person therapy or virtual therapy
• Medicine: Some people may benefit from medicine to treat depression, anxiety or other conditions.
• These treatments are not exclusive and are often used together to treat mental health conditions.

You have several options for finding a mental health professional:

• Ask your doctor or social worker for a referral or recommendation
• Ask your health insurance company for a list of covered providers
• Ask a trusted family member, friend or religious leader for recommendations

Talk to your doctor about treatment options

Many people feel stigma around taking medicine for mental health, but caring for your mind is just as important as caring for your body. Mental health conditions are real medical issues, just like high blood pressure and sometimes medicine is needed to treat them. Getting help is a sign of strength, not weakness. There are safe and effective medicines to help when you are struggling with mental health issues. 

There are many medicines available, but the most common are:

• Antidepressants: treat depression, but can also treat anxiety and other conditions
• Anti-anxiety: treat anxiety disorders

A psychiatrist will work with you to figure out which medicine is best. Some medicines may interact with your treatment for kidney disease. It is important to work closely with your psychiatrist and kidney doctor to make sure you are on the best medicine to treat your condition.

If you are having thoughts of suicide or feeling like you may harm yourself, please know you are not alone. Call or text 988 right away to connect with the Suicide & Crisis Lifeline and talk to someone immediately.