It is well recognized that depression represents a significant co-morbidity for patients already confronted with chronic medical conditions. Individuals with kidney disease are not an exception to this observation. Many potential psychological, social, and biological contributions to the high rate of depression in patients with end-stage renal disease (ESRD) have been identified. Patients with ESRD on dialysis often suffer the loss of work status and time, health, and independence. Approximately one in four patients with ESRD chooses to voluntarily discontinue dialysis treatment. Many different classes of antidepressants have been used in this complex patient population. The medications most often utilized include the selective serotonin reuptake inhibitors (SSRIs) and the serotonin-norepinephrine reuptake inhibitors (SNRIs). The administration of tricyclic antidepressants (TCAs) in patients with renal disease is rife with potential complications. Electroconvulsive therapy has been used in patients with ESRD, and it appears well tolerated and effective in this patient population.

Treatment decisions regarding diabetic neuropathy (DN) can be made based on useful evidence. Many agents have been assessed for therapy of DN pain, and many have some role in relief of symptoms. The opioid tramadol, which has additional (monoamine-related) mechanisms of analgesia, has particular utility in DN. The tricyclic antidepressants (TCAs) are among the most consistently effective therapy for neuropathic pain. Multiple RCTs have demonstrated the efficacy of the serotonin-norepinephrine reuptake inhibitor (SNRI) duloxetine in the treatment of DN. A withdrawal syndrome can occur if the SNRIs are abruptly discontinued. Anticonvulsants are a valuable therapeutic option in DN. Pregabalin is effective for DN as well. Topical application of local anesthetics may be useful in patients with focal DN pain. Patch application of lidocaine is known to be effective in DN. Intravenously injected local anesthetics have been reported potentially useful in DN.