1. ¹Department of Epidemiology and Healthcare Research, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
2. ²Institute for Health Outcomes and Process Evaluation Research, Tokyo, Japan
3. ³Graduate School of Medicine, University of Tokyo, Tokyo, Japan
4. ⁴University Renal Research and Education Association, Ann Arbor, Michigan, USA
5. ⁵Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
6. ⁶National Institute for Environmental Studies, Environmental Epidemiology Section, Tsukuba, Japan
7. ⁷Department of Blood Purification and Internal Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
8. ⁸Department of Nephrology, Showa University School of Medicine, Tokyo, Japan
9. ⁹Koga Red Cross Hospital, Koga, Japan
10. ¹⁰Division of Nephrology, Endocrinology and Metabolism, Department of Medicine, Tokai University School of Medicine, Isehara, Japan
11. ¹¹Research Center for Advanced Science and Technology, University of Tokyo, Tokyo, Japan

Correspondence: S Fukuhara, Department of Epidemiology and Healthcare Research, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan. E-mail: fukuhara@pbh.med.kyoto-u.ac.jp

Received 3 February 2006; Revised 31 May 2006; Accepted 25 July 2006; Published online 4 October 2006.

Abstract

Many hemodialysis patients in Japan have symptoms of depression, but whether those patients are treated appropriately is unknown. As part of the Dialysis Outcomes and Practice Patterns Study, data on symptoms of depression, physician-diagnosed depression, prescribed medications, and death were collected prospectively in cohorts in Japan (n=1603) and 11 other countries (n=5872). Symptoms of depression were as prevalent in Japan as elsewhere, but in Japan a much smaller percentage of patients had physician-diagnosed depression: only 2% in Japan vs 17% elsewhere. Antidepressants were much less commonly prescribed in Japan: only 1% in Japan vs 17% elsewhere for patients with many and frequent symptoms of depression, and 16% in Japan vs 34% elsewhere for patients with physician-diagnosed depression. In Japan, symptoms of depression were associated with prescription of benzodiazepines (without antidepressants), and patients with physician-diagnosed depression were twice as likely to be given benzodiazepines: 32% in Japan vs 16% elsewhere. Benzodiazepine monotherapy was associated with death (relative risk 1.56, 95% confidence interval (CI), 1.25–1.94), even after adjustments for 13 likely confounders (relative risk 1.27, 95% CI, 1.01–1.59). Hemodialysis patients in Japan with symptoms of depression are given not antidepressants but benzodiazepines, a practice associated with higher mortality.