Nephrologist said that CKD will lead to mental/psychiatric impairment!?

[Athena]

I saw a new nephrologist recently whom I have started seeing last year. My recent lab results showed that my kidney function has not worsened & is stable  . I have though been feeling quite terrible on a mental/emotional level and decided to open up to the new nephrologist. The response was startling & rather overwhelming. She said that CKD will inevitably lead to "mental" impairment and wanted to prescribe an antidepressant & refer me to a psychiatrist. I felt stunned. While it seems tantalising to try to access another type of medical assistance in the fight against CKD, my enquiries have only lead me to feel very cautious and concerned. So just a few questions.

Is it true that CKD will lead to "mental illness"? Please discuss.

Are patients with other serious life-threatening medical conditions (eg cancer) also assigned the label of mental illness? I am quite curious about this from the point of kidney disease advocacy.

Are there any legal issues that can arise from allowing any physician to start using the "mentally ill" label.

Is it actually safe to see a psychiatrist? I have only ever heard quite negative things about shrinks & have even been told this in the recent past from a counselor. I would like to hear of any other person's actual experience.

[OldKritter]

You say you are struggling with mental/emotional stress (depression?) but you did not share this information with your original doctor.   It’s good you told your current doctor even though she seems a bit aggressive. 

Mental illness was a poor choice of words but I think your doctor is on the right track.  You probably don’t need medication but need to freely and frankly talk with someone about your emotional status.   

[Charlie B53]

Every person suffering from disease suffers from Depression to one extent or another.  This is perfectly Normal and Expected.  How you handle your level of depression is the difference. There are many stages of mental state that come with every major change in life, some people make the transition through these stages easily, others not so and of these people some do well with counseling, some require medication, some need both.  ALL are still within the realm of 'Normal' behavior.

Self realization and seeking help when you need it is a major factor, finding the method that works for you is a huge step in coping.  You will do fine.

Society has become so sensitized by the constant doom and gloom of the network news that people are in a rush to enact laws that are 'intended' to protect society but in effect are limiting rights of individuals.  Government is currently directed medical personnel to report 'mental' patients of some classifications and are attempting to limit the gun rights of some of these individuals.  It can be arguable whether this is a good thing or not.  I think it all depends on the person, but society being so quick to hang 'labels', paint with a very wide brush.

[MooseMom]

Oh, Athena, your experience with your neph makes me feel really angry on your behalf.

No, CKD doesn't cause mental illness.  That's absurd.

But OldKritter is correct in saying that the anxiety, frustration, fear and other forms of emotional stress can certainly lead to clinical depression, and who would be surprised by that?  It's not the CKD, rather, it is all of the negative feelings that go with having to manage a scary and chronic disease.

The emotional side of these things is almost always ignored by doctors.  I've always felt that practices that have doctors who are in fields where they may have to give bad news (nephrology, oncology for example) should have on hand a list of counselling practices that specialize in dealing with people with medical issues.

My husband has an acquaintance who is relatively young, has two kids and is struggling with MS which is suddenly getting a lot worse.  She feels an understandably high level of fear and anxiety.  She is taking Xanax.  She has not been labelled as being "mentally ill", but it is obvious that she is rightfully frightened and tense.  I confess that I do not know if she has seen a psychiatrist.  A psychiatrist can prescribe meds and is probably better at prescribing the right thing than those docs who manage patients with serious conditions.  Although, it is entirely possible that certain numbers of those docs have seen so many of their patients having to cope with anxiety that they know best which meds work better with MS patients. 

It might be helpful to speak with a psychologist, but I don't believe they can prescribe meds.

I saw a psychiatrist once.  She kept banging on about how meds she could prescribe could cause weight gain.  She was a bit portly herself, so maybe that influenced what she was telling me.  My husband accompanied me, which was a mistake.  He and the psychiatrist ended up in an argument, and I never went back.

Anyway, no, you are not going to end up being mentally ill!  But you don't have to suffer with anxiety, either.   

[LorinnPKD]

I'm gobsmacked.

A nephrologist is not a mental health professional and your doctor is totally overstepping her position here.

Yes, depression and anxiety often go hand in hand with chronic illness.  I certainly dealt with depression and anxiety after my initial diagnosis, and my initial diagnosis came at a time when my life was in a lot of upheaval (divorce, downsized at work, got diagnosis and decided firmly not to have children, moved across country, started new job where I was way over my head, etc.). Looking back, I am confident I would have benefited by talking to a therapist just to keep myself on track, and I wish I had done so.  Weirdly, being on dialysis is less stressful for me than 10 years of worrying about what dialysis would be like.

And remember, therapists/psychologists do not prescribe drugs; psychiatrists can.  While I am not against taking anti-depressants, I believe people should try talk therapy first.  My social worker at dialysis says I'm doing well but says that everyone can benefit from talk therapy, especially those with chronic illness, regardless of how whether they generally feel OK, so I am thinking about finding someone.  Non-drug techniques like Cognitive Behavioral Therapy really do work and can help with general coping.  It doesn't mean you are "mentally ill."




 

[Charlie B53]

I will have to look for that thread about an article on a study of the effects on the brains of CKD Patients.  There was some measured correlation of reduced cognitive function of older patients, more so with Dialysis Patients than with a control group of none-dialysis patients.

The article DID mention that there are those patients with lifestyles that actively engage brain functions, i.e. reading, playing games, working puzzles, had measurably LESS decline in function than those more 'idle' patients.

I may have made a comment relating their findings to the old adage 'If you don't use it, you lose it.' How the brain, some what like other muscles, fairs far better with regular use, exercise if you will call it that.

Statistically, if you keep your mind occupied actively engaging yourself, you will do far better, and longer, than most others who do not.

Oops!  Correction;

I would NOT spend another moment stressing over anything a Neph thinks about how your mind works.

[Simon Dog]

The article DID mention that there are those patients with lifestyles that actively engage brain functions, i.e. reading, playing games, working puzzles, had measurably LESS decline in function than those more 'idle' patients

I recommend crossword puzzles as a great way to while away the time while dialyzing.

https://www.boatloadpuzzles.com/playcrossword  - Easy

http://puzzles.usatoday.com/ - A bit harder

http://games.washingtonpost.com/games/daily-crossword/ - Even harder

I suspect the NY times on line crosswords are even harder, but they require a pay subscription.

[Charlie B53]

On my 'other' laptop today so I am not able to get into the links I have, but I 'thought' I have a link to NY Times puzzles, and they ARE tougher than many others. Back when I worked in an Office there were three of us that got together over coffee and between us we often managed to finish, were any one of us alone couldn't.  The power of 'Group Think' is real.

[Athena]

You say you are struggling with mental/emotional stress (depression?) but you did not share this information with your original doctor.   It’s good you told your current doctor even though she seems a bit aggressive. 

Mental illness was a poor choice of words but I think your doctor is on the right track.  You probably don’t need medication but need to freely and frankly talk with someone about your emotional status.   

Yes I have discussed all of my concerns with my original doctor and he has only been supportive, empathetic and has been keen to assist in whatever capacity he could as a nephrologist & also as primary health care provider &, I suppose, as a counselor of some sort. I've made an appointment to see him again. Better the devil we know than the devil we don't know, as the saying goes. My reason for seeking another Neph was solely to do with location & factors to do with that.

[smartcookie]

Dialysis patients often suffer from situation depression or anxiety.  Sometimes this can turn into a major depressive disorder or anxiety disorder if not taken care of, but that is not always the case.  From my experience, a lot of patients simply need to vent those frustrations, fears and anxieties.  Situational depression and anxiety are a normal response to the rigors of dialysis.  Your whole life has changed!  You have a new schedule, new medicines, new feelings, new diagnoses, etc.  It is normal to feel fear, depression or nervousness about it.  It is normal to have a roller coaster of emotions.  Even if you are not new to dialysis this can happen.  Dialysis treatments are constantly changing due to new medical issues, dry weight, new medicines, new techniques, etc.  I would not say that dialysis causes mental illness.  I think that if you don't take care of yourself mentally and vent appropriately, then you can be at risk for depression issues.  Sometimes even situational depression and anxiety need a medication to help you over that hurdle.  I have patients that will take Xanax or Zoloft for a couple months and then can come off those medicines.  Heck, I even have a patient that I am pretty sure has seasonal affective disorder.  She always needs an antidepressant in the winter, but not in the summer!  Take what your nephrologist said with a grain of salt.  Yes, you may need some therapy, but that doesn't mean you are mentally ill, it means you are a human being going through something really tough!  And that is okay.  It is normal.   







sp mod Cas

[Shaks24]

Well after 3 years of PD I seem to have fallen into this trap. I usually get down in the winter but this year has been terrible. I broke down and discussed it with my care team at my last Doctor visit. He prescribed me a low dose of Lorazepam to take as needed. It helps but I am still struggling with anxiety but I try to limit the medication to really bad days. I am hoping when spring breaks I can be more active and that will help things. If not I will seek out help with a mental health provider. In a way its hard to admit this but it is what it is. Never in my life have I felt this unsure about things. I hope it gets better soon. I do participate in some facebook dialysis support groups and there seem to be quite a few folks who take anti anxiety/depression medications.

[kristina]

I saw a new nephrologist recently whom I have started seeing last year. My recent lab results showed that my kidney function has not worsened & is stable  . I have though been feeling quite terrible on a mental/emotional level and decided to open up to the new nephrologist. The response was startling & rather overwhelming. She said that CKD will inevitably lead to "mental" impairment and wanted to prescribe an antidepressant & refer me to a psychiatrist. I felt stunned. While it seems tantalising to try to access another type of medical assistance in the fight against CKD, my enquiries have only lead me to feel very cautious and concerned. So just a few questions.

Is it true that CKD will lead to "mental illness"? Please discuss.

Are patients with other serious life-threatening medical conditions (eg cancer) also assigned the label of mental illness? I am quite curious about this from the point of kidney disease advocacy.

Are there any legal issues that can arise from allowing any physician to start using the "mentally ill" label.

Is it actually safe to see a psychiatrist? I have only ever heard quite negative things about shrinks & have even been told this in the recent past from a counselor. I would like to hear of any other person's actual experience.

What a strange, confusing statement of this nephrologist to indicate that "CKD will lead to mental/psychiatric impairment"...
I have never heard or read of such a thing and it makes me a bit angry...
Of course it is a horrific and depressing moment to find out to be in CKD ... or any other chronic disease,
but that does not mean that CKD itself will lead to mental phsychiatric impairment...
Of course there can be mentally impaired patients who need dialysis,
but the one I have met at "my" Dialysis-center was born with mental impairments.
Please make sure that this nephrologist has no chance to confuse your mind
with further upsetting unprofessional statements...
Best wishes and good luck from Kristina.

[Charlie B53]

Google 'Light Therapy'  Read, a LOT.  It is real, and it works.

Most everyone is affected to some extent or another.  It is a normal seasonal disorder caused by the lack of sunlight.  Many animals slow down in the fading light of shorter days.  Example, bears, many can feed, fatten, and hibernate the majority of the winter, awakening when the days begin to lengthen.

I have change EVERY light bulb in our house to the curly flouro's with a temp of at least 5000K to get the whitest light possible.  Temps cooler have a yellowish tent and I have far more symptoms of the light deficit. And it's neat that I can use 100 Watt equiv flouro bulbs without using near that much electricity.  I can afford the LIGHT.

Bathroom, kitchen, and garage where I spend most of my time are the brightest.  It really helps me to wake up, get around, making my coffee, smoking cigarettes while I watch the morning news on the garage TV.  By the time I had to go to work I was about as charged as a solar panel.

I've cut back to just the one cup of coffee so it ain't the caffeine getting me going.  It's the light.

I had to Retire from work in '08, but my morning routine remains the same.

[Athena]

The article DID mention that there are those patients with lifestyles that actively engage brain functions, i.e. reading, playing games, working puzzles, had measurably LESS decline in function than those more 'idle' patients

I recommend crossword puzzles as a great way to while away the time while dialyzing.

https://www.boatloadpuzzles.com/playcrossword  - Easy

http://puzzles.usatoday.com/ - A bit harder

http://games.washingtonpost.com/games/daily-crossword/ - Even harder

I suspect the NY times on line crosswords are even harder, but they require a pay subscription.

Simon, even in my high functioning college years, I was not attracted to crossword puzzles & they always seemed to be a bit too hard whenever I'd tried to solve one. What is it about crossword puzzles that makes them so beneficial for brain power? Are there other mentally enriching activities apart from this activity? I did play chess in my youth ... if I went back to that, would that activity do the trick? 

[Athena]

Oh, Athena, your experience with your neph makes me feel really angry on your behalf.

No, CKD doesn't cause mental illness.  That's absurd.

But OldKritter is correct in saying that the anxiety, frustration, fear and other forms of emotional stress can certainly lead to clinical depression, and who would be surprised by that?  It's not the CKD, rather, it is all of the negative feelings that go with having to manage a scary and chronic disease.

The emotional side of these things is almost always ignored by doctors.  I've always felt that practices that have doctors who are in fields where they may have to give bad news (nephrology, oncology for example) should have on hand a list of counselling practices that specialize in dealing with people with medical issues.

My husband has an acquaintance who is relatively young, has two kids and is struggling with MS which is suddenly getting a lot worse.  She feels an understandably high level of fear and anxiety.  She is taking Xanax.  She has not been labelled as being "mentally ill", but it is obvious that she is rightfully frightened and tense.  I confess that I do not know if she has seen a psychiatrist.  A psychiatrist can prescribe meds and is probably better at prescribing the right thing than those docs who manage patients with serious conditions.  Although, it is entirely possible that certain numbers of those docs have seen so many of their patients having to cope with anxiety that they know best which meds work better with MS patients. 

It might be helpful to speak with a psychologist, but I don't believe they can prescribe meds.

I saw a psychiatrist once.  She kept banging on about how meds she could prescribe could cause weight gain.  She was a bit portly herself, so maybe that influenced what she was telling me.  My husband accompanied me, which was a mistake.  He and the psychiatrist ended up in an argument, and I never went back.

Anyway, no, you are not going to end up being mentally ill!  But you don't have to suffer with anxiety, either.   

Thanks Moosemum for this reply. You are lucky that your husband argued with that psychiatrist, for my reading & research has revealed that these type of meds can indeed have serious side-effects, including weight gain. Some of the other side effects can be deadly for a kidney patient, namely electrolyte imbalances which we are at more risk of, as it is. Severe electrolyte imbalances is what I've already experienced in reaction to a hormone med in the past which worsened my kidney function permanently. So my conclusion is, as tempting as it may be to simply take a pill to feel better, I think it may be a case of jumping out of the 'frying pan into the fire'.

[Michael Murphy]

I think CKD makes some people crazy,  look what it's done to the doctor.  She is clearly crazy as a loon.  Being depressed by a future that I ncludes dialysys is not a sign of mental illness.  The name of this site is not I love  dialysis for rather good reasons.

[Jean]

    

[Athena]

I think CKD makes some people crazy,  look what it's done to the doctor.  She is clearly crazy as a loon.  Being depressed by a future that I ncludes dialysys is not a sign of mental illness.  The name of this site is not I love  dialysis for rather good reasons.

Michael, I don't know if your comment was just made in jest or not but I think you really have hit the nail on the head! Thank you. I think this new nephrologist has really messed me up since making that original statement. In addition to wanting to prescribe SSRIs, she also wanted to prescribe a dangerous BP medication that is actually contraindicated for severe renal impairment. I am still shaking my head in disbelief.

I have been back to see my original long-term nephrologist of several years now as well as my PCP of several years & even others & it was business as usual in that respectful, supportive, professional way it has always been. One of the two actually said in passing that I do not have a mental illness and that my worried questioning stance about my medical issues is doing more to help me than in most patients he sees.

I think the mental health medical industry is a growing lucrative one & I think that people who are dealing with chronic illnesses like CKD need added legal protections against this type of abuse. I have in my research actually spoken to an expert academic psychiatrist to ask questions and I am still shaking my head in disbelief at what I've learned ...

My advice to anyone is to stick to doctors one likes and above all, TRUST. Beware of confiding in any new doctor about how hard it is to be dealing with CKD.

The good news is that my long-time Neph has put me through another round of kidney function lab tests plus a whole host of other tests & all my results were very good! He called me as soon as he saw the good results to tell me over the phone. I'm just over the moon.

[cassandra]

The good news is that my long-time Neph has put me through another round of kidney function lab tests plus a whole host of other tests & all my results were very good! He called me as soon as he saw the good results to tell me over the phone. I'm just over the moon.

                      Well done you!!

[Michael Murphy]

Growing up I was told never date a person more crazy then you.  I think that applys to doctors as well.  Rember 50 percent of doctors graduate in the bottom half of their class.

[Rerun]

No, dialysis does not make you mental. 
 

[Athena]

Growing up I was told never date a person more crazy then you.  I think that applys to doctors as well.  Rember 50 percent of doctors graduate in the bottom half of their class.

Thanks again Michael. Believe me when I say, I am really starting to learn a few things I've never been quite aware of before when it comes to Doctors & the medical profession ... Yes, they can be as crazy as the next person you may encounter on the street. Their incredible workload & stress levels would make them ripe candidates for this.

All this has shown me how important it is for each one of us to be hyper-vigilant and in control with every aspect our medical care. Never completely trust the judgement of any doctor - you may just be patient who came in at the wrong time when cognitive functioning may have started to flat-line!

[Athena]

No, dialysis does not make you mental. 
 

 
Well, even if it does, it would be attributable to physical causes so they shouldn't call it 'mental illness' - they should fix the physical problems first, if they want our minds to work better.

All roads forever lead to one thing & one thing only - the need for a kidney disease fix!

[smartcookie]

I learned in school to always check for physical symptoms before diagnosing or suggesting that a patient has a mental disorder.  For instance, an older adult who is presenting as confused and depressed may have a UTI or on a medication that does not suit him/her.  UTI's are notorious for causing confusion.  The other day one my patients who has minor dementia issues was completely confused and said that we brought her in off the streets and that her grandson was in the lobby and she needed to go pay a ticket with the police outside.  She said she had never been to this dialysis facility (she has been coming to my clinic for three years) and that she did not know anyone.  Turns out the RN put her on a different row so the whole clinic looked different and new to her.  I did the white lie for dementia patients technique... I told her that I paid the ticket for her, gave her grandson snacks in the lobby and turned on a movie for him and that her normal dialysis facility was full today so they asked us to take her.  I told her we had all her records and even had the rounding doctor come by and corroborate the story.  She was fine the rest of treatment that day.

[Athena]

I learned in school to always check for physical symptoms before diagnosing or suggesting that a patient has a mental disorder.  For instance, an older adult who is presenting as confused and depressed may have a UTI or on a medication that does not suit him/her.  UTI's are notorious for causing confusion.

I do not have a UTI but Nephrologist did advise that severe constipation can "cause confusion" in some patients. That is now on the To Do list to tackle.