|Treatment and Depression
May 31, 2004
I was recently diagnosed with acute HIV while hospitalized for meningitis and a whole host of other symptoms. I am in my first month of treatment (Sustiva, Viread and Epivir) and have survived what I hope have been the worst of the side effects (sleep disorders, rash, cramping, stomach pain, pain in palms and soles). I am however concerned that my mental state is deteriorating. I have informed my HIV Docs about my history of depression (incl. bouts of mania) however I find it extremely difficult (always have) to talk with anyone about this and have a tendency to be completely positive and appropriate in the company of others. I understand that the reality of the diagnosis itself can bring about depression but have found that I am falling into old patterns (bullemia, racing thoughts) which themselves do not inspire discussion with loved ones.
I believe that I am honestly handling the news of my diagnosis and have the love and support of my partner. The HIV docs I have been seeing have been great, even going so far as to call me at home a few times a week to check in on me. I guess that I want to believe that this recurrence of my psychiatric symptoms has to be a side effect of the treatment and would like to know if there is any general concensus on the duration of these effects? I dislike taking anti-depressants and talk therapy seems too self-indulgent. I understand that side effects are different for everyone but am I at least justified in being hopeful that like my rash, this too will pass.
| Response from Dr. Young
Thanks for your question.
It does sound like you're potentially having psychiatric symptoms that could be exacerbated by your medications-- while there's some controversy about the extent to which efavirenz (Sustiva) can cause delayed psychiatric symptoms, I think that many doctors can describe cases where this seems to be the case. Most of the side effects seem to abate after 4 weeks of therapy, but in either case, developing a discussion about your symptoms is important for you and your doctor. It could also be a case that your depressive symptoms are reasonably worsened after the new diagnosis of HIV.
Worse case, there are a number of medications that could be considered as alternatives to efavirenz should you and your doctor feel this is warranted.
Good luck, BY
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