Hormone Changes and Deficiencies
Testosterone deficiency frequently causes depression, fatigue and loss of sexual desire in both men and women living with HIV. The appropriate use of transdermal testosterone patches or gels to return testosterone to optimal levels can help eliminate depression and fatigue if testosterone deficiency is the cause. A Columbia University study showed that 79 percent of HIV-positive men who had been diagnosed with depression and had low blood levels of testosterone had their depression reversed and their mood improved with testosterone replacement therapy.
It is possible for the hormonal changes that occur during and around menopause to cause depression or anxiety. Testing of hormone levels followed by discussion with your doctor of what can be appropriate for replacement therapy is very important. See Menstrual Changes for more information about menopause.
Thyroid hormone deficiency (called hypothyroidism) is a problem for some people with HIV. It can cause fatigue, depression, foggy thinking and difficulties with focus and concentration. Talk to your doctor about whether thyroid function tests should be a part of your regular blood tests. In people who have low thyroid hormone levels, restoring their thyroid hormones to optimal levels can create mental focus and physical energy, though it may take weeks to months of supplementation before these levels return to normal. Hormones tend to work slowly so patience is necessary.
Stress may be causing your anxiety or depression. Many people face stressors in their relationships, finances and work. Living with a disease like HIV or other chronic illness can add to that stress. Stress reduction can come from a combination of behavioural strategies and counselling with a good mental health professional, along with meditation, other relaxation techniques or homeopathic remedies. See the discussion of St. John's wort below, and check with your doctor or pharmacist about any potential drug interactions between the medications you take and any complementary therapies you are considering.
There are many simple self-help techniques that can help deal with anxiety, including:
- Deep, slow breathing -- Concentrate on taking slow, steady breaths. Breathe in to the count of four, pause and breathe out to the count of four. Repeat. Find some time every day to focus on your breath and slow it down.
- Relaxing -- Tense up each muscle in your body, one at a time, then release it to see how a relaxed muscle feels. A hot bath with aromatherapy oils or Epsom salts or getting a massage also helps to relax muscles.
- Laughing -- Studies show that laughter reduces stress.
- Living in the here and now -- Life with HIV can be all about living in the past with regrets or in the future with worry about what lies ahead. Find some time every day to try to let go of the past and future and live in the moment.
- Appreciating the good things -- Every day, try to count five things in your life that you are grateful for. This reinforces a positive attitude.
- Problem solving -- If the source of your stress is something you have control over, try to address it and eliminate the root cause.
- Talking about your fears -- Keeping your fears bottled up makes them worse. Find a friend, a counsellor or an elder you can talk to about your biggest fears and worries.
- Learning about stress reduction -- Many complementary therapies teach relaxation and stress reduction. Some community organizations offer free massage, yoga and meditation classes.
Eating, Sleeping, Exercising and Socializing
A healthy lifestyle contributes to mental and emotional health. Eating a nutrient-rich healthy diet is important for mental and physical health in people with HIV. Many studies have shown that regular exercise can help to improve mood and counter anxiety, stress and depression. Getting a good night's sleep is also very important for maintaining a good mood in general, as well as for ensuring you have sufficient energy to address your health and well-being.
Socializing with friends and family and finding social support can contribute significantly to emotional wellness, too. People with HIV who are isolated or have little social support are more likely to experience depression and anxiety. Making the effort to socialize, or joining a peer support group can be very helpful for restoring and maintaining good emotional health.
Seeking Professional Help
In addition to finding support within your circle of family and friends, you may want to reach out to healthcare providers. A good place to start is with your family doctor or HIV specialist. They can work to uncover any medical causes, and they can refer you to mental health professionals such as counsellors, psychologists or psychiatrists for more help.
Talk therapy, either one-on-one or in a group, can be very effective in dealing with emotional problems. If you are feeling emotionally unwell, it is crucial you have someone to listen to you, understand your feelings, give you support and help you understand what is troubling you. Antidepressant medication may also be part of the solution.
Using Antidepressant Therapies
Antidepressant medications may also be needed to treat depression, anxiety and other mental health issues common in people with HIV. There are many different antidepressant medications available today; you may need to try more than one to find the medication that works best for you.
Medications that are most commonly used today for the treatment of depression are called selective serotonin reuptake inhibitors (SSRIs). They work on serotonin, the brain's "happiness chemical." Because it is a serotonin precursor, 5-HTP (5-hydroxy-tryptophan, related to tryptophan) may also work for countering depression. (See Sleep Problems for more on 5-HTP supplements.) Many people have found that combining 5-HTP supplementation with other emotional wellness strategies is a successful solution for depression. However, 5-HTP should not be taken by people who are also taking medicines to treat depression or anxiety.
Be sure to tell your pharmacist or doctor about all the medications, over-the-counter drugs, supplements and herbal therapies you take. These products can interact with your antiretroviral drugs, causing them to become less effective or increasing the risk you will experience side effects.
The herb St. John's wort is widely used as a natural antidepressant but it can interact with many medications, including antiretroviral drugs. It should never be used without consulting with your doctor or pharmacist regarding the possibility of drug interactions.