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Depression

Question:

I have being feeling very down for the past three months; sometimes I can’t stop crying.

I can’t seem to bring myself to see friends or even go out, except to go to the store. My best friend thinks I might be depressed. What can I do to “snap out of it?”

The essentials:

  • Clinical depression is different from the ordinary everyday sort of “funk” or temporary feelings of unhappiness.
  • Depression is extremely common in people with HIV—up to 40% of HIV+ people experience it.
  • Common symptoms include feeling low and/or irritable, lack of pleasure from daily living, feelings of hopelessness, fatigue, difficulty concentrating or remembering things, loss of sex drive, eating much more or less than usual, and sleeping much more or less than usual.

More details:

Depression is not the same as grief or sadness, although they may appear to be the same. Sadness and grief are normal, healthy reactions to traumatic events. Depression goes beyond simple sadness, usually lasting longer, and making the person unable to deal with day-to-day life.

Depression can have many causes. Some HIV meds (such as Sustiva) may contribute to depression in some individuals. Also, other physical conditions can “mimic” depression by causing similar symptoms. For instance, advanced HIV disease, anemia, vitamin B12 and other nutrient deficiencies can all cause fatigue and trouble concentrating. “Dementia”—impaired mental functioning due to HIV or other infections—can cause similar problems as well. It is important to get a proper medical diagnosis so that the appropriate problem can be identified and treated.

There are many types of depression. Some involve only low mood. Others can also involve excessive mood elevation and “sped-up” thinking (mania), or considerable anxiety and agitation. It is important to ensure that you get properly diagnosed.

Treatment advice for people with depression:

  • Like other illnesses, depression is not something the person caused. It is something to be acknowledged and treated, just like any other illness.
  • There is no shame in acknowledging that you are depressed, or in taking antidepressants or other treatments.
  • Depression can’t get be gotten rid of in a day by doing any one thing; improvement tends to be gradual.
  • Getting help is an important first step.

How is depression treated?

Depression can be helped by a variety of treatments including:

  • Psychotherapy and supportive counselling (“talk therapy”)
  • Alternative and “self-help” approaches
  • Antidepressant medications

Counselling and psychotherapy:

People with depression should see a mental health professional, hopefully one who is familiar with HIV issues. Counselling and “talk therapy” can help deal with stressful and upsetting issues that can contribute to depression.

Complementary/alternative approaches include:

  • B12—Many HIV+ people are low in B12. Injections or sublingual form (chewable/dissolvable under the tongue) recommended.
  • High dose Omega-3 fatty acids (e.g. deep sea salmon oil)—Excessive doses may contribute to mania in some persons. Consult with your pharmacist or physician about safe doses.
CAUTION against two supplements commonly used to treat depression:
St John’s Wort (Hypericum perforatum) interacts with many HIV and other medications. Not recommended.
Kava kava can cause severe liver toxicity. Banned by Health Canada.
  • Light therapy—Use of a light board or visor that radiates specific spectrum of light comparable to early morning summer sunlight. It must be used correctly to be effective and should not be self-prescribed.
  • Acupuncture—Two controlled studies have shown acupuncture to improve depression and anxiety. Acupuncture must be performed by trained professionals.
  • In mild cases of depression, moderate exercise and relaxation techniques such as meditation have proven of benefit. Other “self-care” techniques such as massage may also help with relaxation and lowering anxiety.

Antidepressant medications:

Depression is associated with low levels of brain chemicals called “neurotransmitters,” such as serotonin. Most antidepressant medications work to restore these chemicals to normal levels. Drugs called “selective serotonin reuptake inhibitors”, or SSRIs, work to restore serotonin levels: these include Anafranil, Celexa, Luvox, Paxil, Prozac, and Zoloft. Other antidepressants, such as Effexor, Serzone, Remeron, and Wellbutrin, work on other chemicals in addition to serotonin. Antidepressants in general are not meant to artificially alter mood, but to restore the brain’s natural chemical balance, allowing the person to regain their normal range of moods.

More information:

Some useful resources from other websites: