Some Background

When you test positive for HIV, your whole world can change in an instant. From who you tell, to picking out your healthcare providers, to monitoring your immune system, and deciding how you want to deal with HIV in your life. There have been more than 700,000 reported cases of AIDS in the United States since 1981 and more than 900,000 Americans may currently be infected with HIV. It is safe to say that we have an epidemic on our hands, that is most rapidly growing in the female and minority populations. It only makes sense to learn about the disease’s side effects and how they can affect your quality of life. As with any diagnosis, a number of side effects can occur simultaneously with your HIV infection. This list is not exhaustive, but can include:

  • Fatigue
  • Anemia
  • Digestive Problems
  • Gas and Bloating
  • Diarrhea
  • Lipodystrophy (body shape changes)
  • High levels of fats and sugars in the blood
  • Skin Problems (e.g., rashes, dry skin, hair loss)
  • Peripheral Neuropathy
  • Mitochondrial Toxicity
  • Osteoporosis
  • Osteonecrosis (bone death)
  • Depression
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Clinical depression is the most commonly observed mental health disorder among those diagnosed with HIV, affecting 22% of the population. If you suffer from substance abuse as well, this rate may be higher. Common emotions after being diagnosed with HIV are sadness and grief, but sadness and grief that morph into full-blown clinical depression are not considered normal responses. Depression can negatively impact your mind, mood, body, and behavior. And it often goes undiagnosed and untreated in those individuals infected with HIV. But, the good news is, just as there have been significant medical advancements helping HIV-positive individuals live fuller, more productive lives, depression treatments help patients better manage both diseases. These treatments can enhance both survival rates and quality of life in individuals suffering from both HIV and depression.

What are the Symptoms?

If you have been diagnosed as being infected with HIV, you should routinely be going for medical visits to best control the infection. In addition to physical tests and examinations, your doctor and/or clinician should also be conducting an annual mental health assessment. Because feelings of depression commonly co-occur with a diagnosis of HIV, many patients may not immediately seek treatment, thinking it is a normal side effect of their diagnosis. Similarly, many clinicians fail to screen effectively for depression so as not to insult the patient.  However, the following symptoms can be caused by depression in HIV-positive patients and should be on your radar:

  • Overall depressed mood
  • Loss of interest or pleasure
  • Suicidal thoughts
  • Feelings of guilt
  • Appetite and weight changes
  • Sleep disturbance
  • Attention and concentration problems
  • Changes in energy level and fatigue
  • Psychomotor disturbance
  • Severe hopelessness or negativism
  • Persistent agitation
  • Pronounced affective instability
  • Maladaptive social functioning
  • Feeling slow and sluggish
  • Decreased sex drive

How is it Diagnosed?

As mentioned previously, your doctor or clinician should be conducting regular mental health assessments to determine if you are suffering from any underlying mental disturbances co-occurring with your HIV infection. After ruling out any physical symptoms, your medical health provider should conduct simple screening techniques that have been shown to be effective in detecting unrecognized depression. Two simple questions have been shown to have great effectiveness in recognizing depression in patients:

  1. During the past month, have you often been bothered by feeling down, depressed, or hopeless?
  2. During the past month, have you often been bothered by little interest or pleasure in doing things?

If you agree with either or both of these questions, you should be asked a series of additional questions to further help in diagnosis. Some follow-up questions your medical care provider may ask you include:

  • Are you having trouble concentrating? Are you able to follow the plot of a TV show or a book? Is it harder than usual to make decisions?
  • When people are ill and feeling depressed, they often want to just “get it all over with.” Have you felt that way? Have you thought about killing yourself?
  • You look a little jumpy/slow; are you feeling more restless/moving more slowly than usual? Has anyone else noticed this?
  • I notice that you’ve lost/gained weight. Are you feeling more/less hungry, eating more/less than usual?
  • Do you blame yourself for things you have no control over?
  • Are you having trouble enjoying sex?
  • Are you fighting with your spouse or family?

Certain behavioral changes may also be indicative that a person diagnosed with HIV is also suffering from depression. Your clinician should pay attention to the following changes in your behavior that may also help them pinpoint a depression diagnosis:

  • Unexplained medical complaints, such as pain or fatigue
  • Changes in treatment adherence
  • A change in functioning to include things such as inability to perform daily living activities, self-imposed isolation, a start of substance abuse, or a return to substance abuse
  • Inability to make life choices related to medical care and HIV infection treatments
  • Being preoccupied with particular problems – these problems usually are minor in comparison to other problems in your life
  • Interpersonal problems
  • Showing of difficult behaviors in medical settings

What Causes Depression in HIV Patients?

This may sound like an obvious question. However, HIV infection itself does not cause depression, nor does the progression of the disease automatically lead to depression. Critical “crisis points” are common “entry” points of a depressive state in HIV-infected individuals. These common crisis points include:

  • Initial HIV diagnosis
  • Telling friends and family that you have been HIV-infected
  • New medication introductions
  • Recognition of new symptoms and disease progression awareness
  • Hospitalization
  • Physical illness
  • Death of a significant other
  • AIDS diagnosis
  • A return to a higher-level of functioning (e.g., going back to work, going back to school)
  • Major life changes (e.g., birth, relocation, change of jobs, loss of a job, pregnancy, end of a relationship)
  • Making end-of-life and permanent planning decisions

How is it Treated?

Depression treatment is critical in patients diagnosed with HIV. If left untreated, depression can cause HIV-infected individuals to stop their treatments, stop going to medical appointments, and to actively not stay engaged in personal care in general. In addition, not treating depression can lead to more risky behavior, including alcohol abuse, drug use, and being careless in behaviors that may infect others with HIV. In addition to making your HIV disease progress at a faster rate than normal, depression can lead to death by suicide and a general overall low quality of life.

The good news is there are treatment options available to help you cope with your depression, which in turn can improve your HIV prognosis as well. Lifestyle changes and medications have both been effective tools in helping those with HIV fight depression.

Antidepressant medications have been proven effective tools in the treatment of depression. If you are on antidepressants and are also coping with HIV, pay close attention to any side effects while on these drugs. This is due to possible interactions between the antidepressants and other medications you are taking for your HIV infection. The most commonly prescribed antidepressants are Selective Seratonin Reuptake Inhibitors (SSRIs) and tricyclics antidepressants. Both can cause side effects, such as loss of sexual desire and function, headaches, insomnia, fatigue, erratic heartbeat, constipation, and upset stomach. All medications should be taken under a doctor’s care.

Certain lifestyle changes have also been found to be effective in treating depression when you have been diagnosed with HIV. These include regular exercise and exposure to sunlight, counseling, stress management, and improved sleeping habits. Massage and acupuncture have also been found as good alternative therapies to depression.

To get the most out of your treatments:

  • Go to routine medical checkups
  • Don’t stop taking your HIV or depression medications (unless advised by a doctor)
  • Learn all you can about both of your conditions – HIV and depression – and learn warning signs and symptoms
  • Avoid drugs and alcohol
  • Regularly attend counseling sessions
  • Stay active
Last Updated: Aug 8, 2019