Understanding HIV and Depression

Identifying the Special Needs of People Living with HIV

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Photograph © Giorgio Montersino

Dealing with HIV can be difficult for some. While it's not unusual to have sad or to want to hide yourself under the bed covers every now and then, when these feelings persist for more than a couple of weeks, you may have a problem. You may have depression.

Depression affects over 10 million Americans each year, and it is estimated that one in four adults will have at least one depressive episode in their lifetime.

In people with HIV, depression can affect more than just your state of well-being; it can affect your overall health as well as the course of your disease.

What Is Depression?

By definition, depression is an alteration in mood that affects a person's ability to function day to day. While short bursts of feeling down or gloomy are normal variations in mood, longer lasting feelings of despair are indicative of depression.

Depression can be manifested both emotionally and physically. Changes in appearance and behavior, as well as physical illnesses such as indigestion, headaches, insomnia, and heartburn, can all be part of a depressive episode. In some people untreated for the condition, suicidal thoughts can sometimes lead to death.

What Causes Depression?

While all the causes of depression are not known, researchers have identified several principal causes. Among them:

  • Reaction to a traumatic experience such as losing a loved one, the loss of a job, or living with a chronic illness over which you have little control
  • Biochemical imbalances in the brain, the episode of which may or may not be triggered by adverse life events
  • Family history or genetic predisposition

What Are the Signs of Depression?

The diagnosis of depression is typically based on a review of the emotional and clinical symptoms of the disease, which can include:

  • Persistent feelings of sadness
  • Feelings of hopelessness, helplessness or guilt
  • Loss of energy and interest
  • A feeling of physical illness or of being rundown
  • Poor concentration
  • Altered appetite and sleep
  • Diminished physical and mental functions
  • Headache
  • Insomnia or oversleeping
  • Indigestion
  • Heartburn
  • Changes in appetite
  • Unexplained weight loss
  • Thoughts of death or suicide
  • Anxiety

Treating Depression in People with HIV

Depression can be treated with the combination of medications aimed at altering the biochemical triggers for depression and on-going psychological counseling to identify the emotional roots of the disease.

There are several types of drug agents used to treat depression. While there are times when one anti-depressive medication will help, doctors will often try several individual drugs or drug combinations until the desired effects are achieved. Most times, it will take at least 3-4 weeks before the full effects of the therapy are realized.

Among the possible drug agents:

  • Serotonin-reuptake inhibitors (SSRIs) such as Zoloft, Prozac and Paxil. These drugs work by increasing levels of serotonin in the brain, thereby improving mood and energy levels.
  • Heterocyclic and other "designer" antidepressants such as Zyban and Effexor. These drugs are designed to work on very specific neurotransmitters in the brain and are know to have fewer side effects than SSRIs.
  • Tricyclics such as Elavi) and Pamelo). This class of drugs was the standard of care prior to the introduction of SSRIs. While very effective for some people, these drugs have more side effects and can be dangerous if overdose occurs.
  • MAO inhibitors primarily used when other antidepressants are ineffective. They are most helpful when treating atypical depressions such as eating disorders and post-traumatic stress syndromes. They can have very serious side effects, most notably high blood pressure.

In addition to medication, treatment should include psychotherapy and other supportive interventions, including support groups, couples/family therapy, and structured self-analysis.

Many types of psychotherapy, including some short-term (10-20 week) courses, can help with depression.

However, when the depression is associated with an individual's HIV, specialist care should be sought to address both the HIV-specific and non-HIV-specific causes of the disease. A therapist needs to fully understand the emotional needs a person with HIV, including overcoming the fear of disclosure, stigma, discrimination, abandonment, and illness.

At the same time, a person with HIV may have concerns that extend beyond the disease itself, including among other things:

  • Disclosure about one's sexual orientation
  • Fear about (or guilt over) infecting others
  • Dealing with issue of infidelity or sexual compulsiveness
  • Dealing with self-destructive practices that put the person in harm's way
  • Alcohol or substance abuse

Having a specially trained therapist can enhance the effectiveness of counseling in people with HIV. To find referrals nearest you, contact your local 24-hour AIDS hotline.