Updated 25 June 2014

HIV and Depression

Depression can affect people’s mind, mood, body and behaviour. Dr Avron Urison of AllLife, writes about the effect it has on HIV positive people and how they might skip their daily medication.

Depression can affect people’s mind, mood, body and behaviour. Dr Avron Urison of AllLife writes about the effect depression has on HIV-positive people and how it might amongst other things cause them to skip their daily medication.
Depression is a common, treatable problem in people with HIV infection.

It may be due to a condition long preceding HIV infection or because of substance abuse. It might also arise during the course of the infection as a result of HIV medication, illnesses, or the overwhelming emotional response to HIV itself.

If not treated or recognised, it can profoundly affect the quality of life and life expectancy of people who are HIV-positive.
About 5% to 10% of the general population get depressed. However, rates of depression in people with HIV are as high as 60%. Women with HIV are twice as likely as men to be depressed. Clinical depression is the most commonly observed mental health disorder among HIV-infected patients.

The prevalence may be even greater among substance users. Depressive symptoms have been associated with risk behaviour, non-adherence to medications, and shortened survival. Failure to recognise depression may endanger both the patient and others in the community.

Skipping medication when depressed

Depression can lead people to skip doses of their medication. It can increase high-risk behaviours that transmit HIV infection to others. Depression might also cause some latent viral infections to become active. Overall, depression can make HIV diseases progress more quickly. A study in 2012 showed that patients with depression, especially women, were more likely to stop receiving care and fail to achieve undetectable viral load.

Symptoms of depression vary from person to person. Most health care providers suspect depression if patients report feeling blue or having very little interest in daily activities. If these feelings go on for two weeks or longer, and the patient also has some of the following symptoms, they are probably depressed:

•     Fatigue or feeling slow and sluggish
•     Problems concentrating
•     Low sex drive
•     Problems sleeping: waking very early, or excessive sleeping
•     Feeling guilty, worthless, or hopeless
•     Decreased appetite or weight loss
•     Overeating

Some medications used to treat HIV can cause or worsen depression and some diseases such as anaemia or diabetes can cause symptoms that appear similar to depression. The same applies to drug use or low levels of testosterone, vitamin B6, or vitamin B12.

Other risk factors include:

•    Being female
•    Having a personal or family history of mental illness, alcohol and substance abuse
•    Not having enough social support
•    Not telling others that you are HIV-positive
•    Treatment failure (HIV or other)

Treating depression

Treating depression can help manage HIV/AIDS and improve overall health. Recovery from depression takes time but treatments are effective. Depression may seem like an unavoidable reaction to being diagnosed with HIV/AIDS, but depression is a separate illness that can and should be treated, even when an individual is undergoing treatment for HIV/AIDS.

Depression can be treated with lifestyle changes, medication and/or alternative therapies. Many medications and therapies for depression can interfere with treatment. Treatment for depression in the context of HIV or AIDS should be managed by a healthcare professional, for example, a psychiatrist, psychologist, or clinical social worker who is in close communication with the healthcare provider managing the HIV/AIDS treatment.

This is especially important when antidepressant medication is prescribed, so that potentially harmful drug interactions can be avoided. Individuals living with HIV/AIDS who develop depression, as well as people in treatment for depression who subsequently contract HIV, should make sure to tell any healthcare provider they consult about the full range of medications they are taking. The healthcare provider will select the most appropriate therapy or combination of therapies.

 Many individuals choose to treat their depression themselves with alcohol or street drugs, which can quicken the progression of HIV to AIDS. Others turn to herbal remedies. Individuals with depression should not try to self-medicate with alcohol or recreational drugs, as these can increase depression and create additional problems.

Lifestyle changes can improve depression in some people.

These include:

•   Regular exercise
•   Increased exposure to sunlight
•   Stress management
•   Counselling
•   Improved sleep habits

Some individuals get good results from alternative therapies such as massage, acupuncture, or exercise. Valerian or Melatonin may help improve sleep. Supplements of vitamins B6 or B12 can help if individuals have low levels of these vitamins.
In essence, recovery from depression takes time. Medications for depression can take several weeks to work and may need to be combined with ongoing psychotherapy. Not everyone responds to treatment in the same way. Prescriptions and dosage may need to be adjusted. However, no matter how advanced the HIV, the person does not have to suffer from depression. Treatment can be effective.

(This column is authored by Dr Avron Urison, Medical Director at AllLife Pty Ltd – providers of life insurance for HIV positive individuals.)

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Dr Sindisiwe van Zyl qualified at the University of Pretoria in 2005. She is a patients' rights activist and loves using social media to teach about HIV. She is in private practice in Johannesburg.

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