Chronic renal failure and end stage renal failure is an established healthcare issue with a growing prevalence. Depression is particularly common in the already physically and mentally morbid patient population with negative adverse consequences on their health and quality of life. Treatment of depression in these patients is not well established in literature and rigorous clinical trials are lacking. Review of available RCTs on treatments modalities were reviewed. Pharmacologic treatments are comparable to non-pharmacologic treatments regarding efficacy. however pharmacologic treatments pose an additional risk to this already medically debilitated patients. It is imperative to consider psychological interventions first when treating depression in patients with chronic renal failure and end stage renal disease patients.