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HIV Spotlight on Center on Caring for the Newly Diagnosed Patient

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Pushing Back Against Challenges to Mental Health and Emotional Wellness

August/September 2014

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Depression

It is normal to feel temporary and mild sadness after learning about unfortunate events that have happened to friends and loved ones. However, in some people, sadness can persist for more than a few weeks and can lead to a serious condition called depression. This can be caused by psychological issues, biological issues or a combination of factors.

Not everyone with depression will have the same signs and symptoms, so trying to self-diagnose depression is tricky and can lead to problems. The best person to help you diagnose depression is your doctor.

According to the U.S. National Institute of Mental Health, people with depression can experience some or all of the following:

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  • feeling sad
  • feeling hopeless, anxious or guilty
  • getting easily irritated or angry
  • feeling tired without having expended energy
  • difficulty concentrating
  • difficulty making decisions
  • memory problems
  • difficulty falling asleep or staying asleep
  • waking up prematurely in the early morning
  • unexpected muscle pain, cramps, headache
  • sudden changes in appetite that result in weight loss or gain
  • loss of interest in regular activities, including sex

If you think you may be suffering from depression, talk to your doctor as soon as possible.

Medical factors that can affect a person's mood can include the following:

  • abnormal levels of thyroid hormone
  • less-than-normal levels of testosterone in men
  • presence of type 2 diabetes
  • untreated hepatitis C virus infection
  • exposure to certain anti-HIV medicines, particularly efavirenz (sold as Sustiva, Stocrin and found in Atripla)
  • exposure to biological agents that affect the immune system, such as interferons (sometimes used in the treatment of hepatitis C) and interleukins


Major Depression

If depression is left untreated it can become severe, leading to major depression. In such cases, some people may develop additional feelings such as thoughts of self-harm or suicide. If this occurs do the following right away:

  • call your doctor
  • if your doctor is not immediately available go to the emergency room of the nearest hospital right away
  • if you are unable to get yourself right away to the emergency room of the nearest hospital, dial emergency services at 911

There are many therapies for depression and your doctor can help you find one that is right for you. It may take some time to find the right medication or dosage that is best for you, so some patience is necessary. Doctors and their patients have found that using a combination of approaches, such as counselling and antidepressants, can be very useful.


Resources

HIV and Emotional Wellness -- CATIE's guide to how people with HIV can cultivate their emotional well-being

Canadian Mental Health Association

Strengthening the aging brain -- TreatmentUpdate

Good for the brain -- advice from neuroscientists -- TreatmentUpdate

Mindfulness-based therapy found helpful for stress and the immune system -- CATIE News


References

  1. Reus V.I. (2012). Chapter 391. Mental Disorders. In Longo D.L., Fauci A.S., Kasper D.L., Hauser S.L., Jameson J, Loscalzo J (Eds), Harrison's Principles of Internal Medicine, 18e.
  2. Schmidt KL. Emergency Medicine: Care of the HIV-positive patient in the emergency department in the era of highly active antiretroviral therapy (HAART). In: Tintinalli JE. eds. Tintinalli's Emergency Medicine Online Updates. New York, NY: McGraw-Hill; 2011.
  3. Blank MB, Himelhoch S, Walkup J, et al. Treatment considerations for HIV-infected individuals with severe mental illness. Current HIV/AIDS Reports. 2013 Dec;10(4):371-9.
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