Depression and Anxiety

A serious, chronic health condition like HIV-infection or AIDS can be depressing. Between 5% and 10% of people in general get depressed. Among people with HIV, as many as 60% are depressed.

Depression is feeling sad, hopeless, worthless or guilty for more than two weeks. Anxiety is feeling worried, fearful or threatened without a cause for a long time. It can range from mild discomfort to a panic attack.

Some people and their caregivers think that depression is part of having HIV infection. In fact, depression can and should be treated.
Depression robs a person of the energy to stay as healthy as possible. It is easy to miss doses of medicine when it feels like nothing matters. When a person feels hopeless, they may see no reason to avoid substance abuse, unprotected sex or other high-risk behaviors.

Depression stresses the body. This can make HIV worse. Depression takes away a person’s ability to enjoy life. 

Symptoms

The signs of depression are often hard to pinpoint. Depression creeps up slowly. Some symptoms are:

• Feelings of guilt, worthlessness or hopelessness
• A racing heart
• A lack of energy or fatigue
• Having a hard time concentrating
• Loss of appetite
• Not enjoying activities that used to be fun or pleasurable; feeling blah
• Irritability
• Little or no interest in sex
• Muscle tension, aches or soreness
• Nausea, diarrhea, or other stomach problems
• Flushes, sweating, chills or cold, clammy hands
• Dizziness or lightheadedness
• Dry mouth
• Feeling anxious or edgy; startling easily; having a sense of baseless dread
• Problems either falling asleep or staying asleep
• Restlessness
• Shortness of breath or a feeling of not being able to breathe
• Skin rashes
• Trembling, twitching, or feeling shaky
• Trouble swallowing; a feeling of having a lump in the throat

Causes

Depression or anxiety can be caused by:

• Life events, such as uncertainty about treatment, money issues, the death of a friend or partner or family problems
• Chemical changes in the brain
• Side effects of anti-HIV drugs. For example, the drug efavirenz (Sustiva®) can cause of make depression worse.
• Physical disorders. Anemia or diabetes can cause symptoms like those of depression. So can substance use, low testosterone or a lack of vitamins B6 or B12. People infected with both HIV and hepatitis B or C are more likely to be depressed, especially if interferon is being used to treat the infections.

Risk Factors

Women, people who have a personal or family history of mental illness or people who have a history of alcohol or substance abuse are at a higher risk of developing depression. 

Prevention

Having a healthy diet and lifestyle, daily exercise and a strong network of friends and supporters can help prevent or control depression. Depression can be a shield against overwhelming things. It is not a sign of weakness. Depression and anxiety should be taken seriously. Treatment is vital when the feelings don’t go away and interfere with daily life. 

Diagnosis

Many illnesses have symptoms like anxiety or depression. It is important to rule those out. A doctor may ask about the person’s:

• Drug and alcohol use
• Family history
• Caffeine intake
• Use of prescription drugs, supplements or herbal preparations
• Recent stressful events in a person’s life
  Blood tests may be done to rule out conditions such as anemia, infections, chemical imbalances, low thyroid or testosterone, and blood sugar levels.

Blood tests may be done to rule out conditions such as anemia, infections, chemical imbalances, low thyroid or testosterone, and blood sugar levels.

Treatment

Treatment helps people manage both HIV and depression. Treatment options include:

• Using the mind and behavior to change feelings. This includes stress management, relaxation exercises, visualizations or guided imagery.
• Psychotherapy. This allows the depressed person to talk through their fears and worries with a trained professional. It can be especially helpful if the therapist has experience with people with HIV infection.
• Antidepressant drugs. These need to be given with care. People with advanced HIV disease are more sensitive to their effects. Some drugs given to fight depression mix badly with anti-HIV drugs. Ritonavir (in Norvir or Kaletra) and indinavir (Crixivan) interact the most with antidepressants. It is important that a person make sure that all of his or her doctors know what drugs and how much of each are being taken. Some drugs used to treat depression have side effects such as a loss of sexual desire, not being able to sleep or stomach upsets. These drugs can take several weeks to build up and become fully effective.
• Lifestyle changes help relieve depression, too. This includes getting enough sleep, regular exercise and time spent in the sunlight. Even 10 minutes of mild exercise can help relieve depression.
• Vagus nerve stimulation is a new treatment approved by the Food and Drug Administration (FDA). A small, watch-size generator is put under the skin of the chest. It sends a signal to a part of the brain related to mood and anxiety.

It is important not to use alcohol or illegal drugs to cope with depression or anxiety. These can make depression or anxiety worse.

Some herbs such as St. Johns’ Wort are said to help depression. However, St. Johns’ Wort interferes with some HIV medicines. Do not take St. Johns’ Wort if you are also taking antiretroviral drugs.