Depression and HIV

Depression can strike anyone. People with serious illnesses such as HIV may be at greater risk. Even when undergoing complicated treatment regimens for other illnesses, depression should always be treated.

Research has enabled many men and women, and young people living with HIV to lead fuller, more productive lives. As with other serious illnesses such as cancer, heart disease or stroke, however, HIV often can be accompanied by depression, an illness that can affect mind, mood, body and behavior. If left untreated, depression can increase the risk for suicide.

Although as many as one in three persons with HIV may suffer from depression, family and friends and even many primary care physicians often misinterpret depression's warning signs. They often mistake these symptoms for natural accompaniments to HIV in the same way that family members and doctors often erroneously assume that symptoms of depression are a natural accompaniment to growing old.

Depression can strike at any age. NIMH-sponsored studies estimate that six percent of 9- to 17-year olds, and seven percent of the entire U.S. adult population experience some form of depression every year—women at twice the rate of men. Although available therapies alleviate symptoms in over 80 percent of those treated, nearly two-thirds of those who suffer from depression don't get the help they need.

Treat your Depression

Persons with depression and HIV must overcome stigma associated with both illnesses. Despite the enormous advances in brain research in the past 20 years, the stigma of mental illness remains. Even people who have access to good health care often fail or refuse to recognize their depression and seek treatment.

Depression is a disease that affects how a person relates to people around them, and if left untreated, can cause relationships to deteriorate. Some people respond to depression by becoming angry and abusive to people who care about them, or children who depend on them. Many choose to treat their depression themselves with alcohol or street drugs, which can quicken HIV's progression to AIDS. Others turn to herbal remedies. Recently scientists have discovered that St. John's wort, an herbal remedy sold over-the-counter to treat mild depression, reduces blood levels of the protease inhibitor indinavir (Crixivan®) and probably the other protease inhibitors as well. If taken together, the combination could allow the AIDS virus to rebound, perhaps in a drug-resistant form.

Prescription antidepressant medications are generally well tolerated and safe for people with HIV. There are, however, interactions among some of the drugs that require careful monitoring.

So, if you or someone you know with HIV is exhibiting the pattern of depressive symptoms described below, seek out the services of a health care provider. And make certain that he or she is experienced in diagnosing and treating depression in people with HIV.

Some of the symptoms of depression could be related to HIV, specific HIV-related disorders, or medication side effects. They could just be a normal part of living. Everyone has bad days.

Clinical depression is different from normal ups and downs

• The symptoms last all day every day for at least two weeks
• The symptoms occur together during the same time period
• The symptoms cause daily events such as work, self-care and child care or social activities to be extremely difficult or impossible.

Taking the above characteristics into account, examine the symptoms listed below and see if they characterize you or someone you know living with HIV:

• Feelings of sadness, hopelessness
• Loss of interest in formerly enjoyable activities, including sex
• A sense that life is not worth living or that there is nothing to look forward to
• Feelings of excessive guilt, or a feeling that one is a worthless person
• Slowed or agitated movements (not in response to discomfort). Recurrent thoughts of dying or of ending one's own life, with or without a specific plan
• Significant, unintentional weight loss and decrease in appetite; or, less commonly, weight gain and increase in appetite
• Insomnia or excessive sleeping
• Fatigue and loss of energy
• A diminished ability to think, concentrate, or make decisions
• Physical symptoms of anxiety, including dry mouth, cramps, diarrhea, and sweating

Many therapies are available, but they must be carefully chosen by a trained professional, based on the particular circumstances of the patient and family. Recovery from depression takes time. Medications for depression can take several weeks to begin to work and may need to be combined with on-going psychotherapy. Not everyone responds to the medications in the same way. Dosing may need to be adjusted. Prescriptions may need to be changed.

Other mood disorders besides depression, such as various forms of manic-depression, also called bipolar disorder, may occur with HIV. Bipolar disorder is characterized by mood swings, from depression to mania.

Mania

Mania is characterized by abnormally and persistently elevated (high) mood or irritability accompanied by at least three of the following symptoms:

• Overly-inflated self-esteem
• Decreased need for sleep
• Increased talkativeness
• Racing thoughts
• Distractibility
• Increase in goal-directed activity such as shopping
• Physical agitation
• Excessive involvement in risky behaviors or activities

People with HIV also have a high incidence of anxiety disorders such as panic disorder.

It takes more than access to good medical care for persons living with HIV to stay healthy. A positive outlook, determination and discipline are also required to deal with the extra stress: avoiding high-risk behaviors, keeping up with the latest scientific advances, adhering to complicated medication regimens, reshuffling schedules for doctor visits, and grieving over the death of loved ones.

The causes of depression are still not clear. It may result from an underlying genetic predisposition triggered by stress, or by the side effects of medications, or by viruses like HIV that can affect the brain. Whatever its origins, depression can sap the energy needed to keep focused on staying healthy, and research shows that it can accelerate HIV's progression to AIDS.

Remember, depression is a treatable disorder of the brain

Depression can be treated in addition to whatever other illnesses a person might have, including HIV. If you or someone you know with HIV is depressed, seek help from a health care professional who is experienced in treating persons with both diseases. Don't lose hope.

Source: National Institute of Allergy and Infectious Diseases, National Institute of Mental Health, July 2000