Findings from the CAST randomized trial published in JAMA suggest that sertraline treatment does not relieve depressive symptoms among patients with chronic kidney disease CKD not on dialysis. Researchers from three U.S. medical centers carried out a study among 201 patients with non dialysis dependent stage 3 11 stage 3A 36 stage 3B stage 4 36 or stage 5 17 CKD and major depressive disorder MDD . All subjects received sertraline 50 mg day to begin with followed by escalation up to 200 mg day as needed or matching placebo for 12 weeks. Among 193 patients in the modified intention to treat sample 92 completed at least 6 weeks and 84 completed 12 weeks of the study with a median treatment duration of 84 days. The primary endpoint ie Quick Inventory of Depressive Symptomatology Self Reported scores at 12 weeks were not different between the two groups. There were low remission rates for depression and the rates were statistically similar with sertraline 15.5 in comparison with placebo 14.6 . The two groups had similar results in measures of overall functioning health and quality of life. Adverse events were more commonly seen with sertraline than placebo 76.1 vs. 60.0 particularly nausea or vomiting 22.7 vs. 10.4 and diarrhea 13.4 vs. 3.1 . The study thus does not support the use of selective serotonin reuptake inhibitors SSRIs such as sertraline for the treatment of depression in patients with stages 3B 4 and 5 non dialysis CKD.