Before acceptance for center maintenance hemodialysis, all 25 patients were significantly depressed—helplessness being the dominant affect. Eighteen patients had suffered meaningful losses and nine of these felt helpless prior to becoming uremic. Three successive periods of adaptation to hemodialysis were observed: the "honeymoon," disenchantment and discouragement, and long-term adaptation. Of 16 patients who experienced a clear-cut "honeymoon," this period ended in 12 patients at the time when they were expected to resume an active and productive role at work or in the household. This was accompanied by depressive affects, helplessness in particular, and by complications at the shunt site, most notably clotting of the shunt.