DEAR DR. MICHAEL SHERNOFF, I RESIDE IN RI. NEWPORT/ PROV.. MY QUESTIONS ARE WHAT IS THE LONG FALL OUT OF DEPRESSION WHEN ON CERTAIN DRUGS THEY ARE ZERIT, VIDEX, VIRACEPT-NELFINAVIR MESYLATE? I HAVE BEEN ON THESE DRUGS AS WELL AS TESTOSTERONE FOR THE PAST 4.5 YEARS AND I AM A 32 YEAR OLD MALE 6.2 240 LBS.. IN THE PAST I WOULD BE DESCRIBED AS AN EXTREMELY HARD-WORKING OUT-GOING PERSON.. UPON MY HIV DISCOVERY I STARTED A COMPANY AS WELL AS SEVERAL LARGE PROJECTS, AND WAS IN A LONG TERM (5 YR) RELATIONSHIP WHICH BECAME VERY BAD FOR MY SOUL AS HE WAS SEARCHING FOR RELATIONSHIPS OUTSIDE OF US.. FOR SEX ETC., .. (MIXED STATUS) I HAVE BEEN A CAREGIVER AS WELL TO PEOPLE WITH HIV/AIDS SINCE I WAS 18 YRS OF AGE.. I WORKED WITH KIDS IN BOSTON AND ADULTS AND THOUGHT I WAS ALWAYS SAFE.. APART FROM THE LOSS OF THE RELATIONSHIP AND THE CLOSING OF MY CO.. ON 1/99 I HAVE COMPLETELY SHUT DOWN AND AM NOT ABLE TO GET OUT OF BED BEFORE 3 PM.. MOST DAYS I HAVE LESS AND LESS WILL TO LIVE AND IT SCARES ME, I REALLY DO NOT KNOW WHAT TO DO.. I HAD BEEN SEEING A THERAPIST, BUT THE ISSUES WERE OLD RESOLVED ONES THAT WE WERE WORKING ON.. I REALLY FEEL THAT THERE IS MORE TO THE DRUGS AND THE LOSS ISSUES THAT ARE BECOMING OR HAVE TAKEN ON A GREAT WIND STORM-LIKE EFFECT IN MY BODY AND MIND... WHAT WOULD YOU RECOMMEND AS I REALLY WANT SO BADLY TO BECOME APART OF LIFE AGAIN. WORKING, FEELING, LOVING, ETC., .. PLEASE HELP..

It certainly sounds like you are suffering from a profound depression, and that you do not feel that your present therapist is helping you. I urge you to begin by being totally honest with him or her about the fact that you are not feeling as if the work you two are doing is getting to the root of your problems. Be blunt about the fact that you are not feeling that this therapist is dealing with your losses, and current medical condition with you in a way that is helping you adjust to living with HIV. Also tell him or her that you plan on consulting other therapists in order to shop around for a therapist who you hope will be better able to help you feel better.

If he or she claims that this is only your resistance, acknowledge that this may be the case, but you plan to see other therapists in order to make up your mind about whether or not to stay in treatment with this person. Hopefully if the therapist is ethical they will explore with you all of the reasons why you are not content with the work the two of you are doing.

Then ask your primary care doctor for a referral to another therapist who is specifically VERY skilled at working with people who have HIV. This is a very important thing to specify. Not every mental health professional has the knowledge and skills to be an effective therapist with people living with HIV and AIDS. You need an expert in this area. You also need a consultation with a psychiatrist who is an expert in psychopharmacology, which is the branch of medicine that specializes in psychiatric medication. You need to have your depression thoroughly evaluated in order for the professional to ascertain with you whether he or she feels that beginning an anti-depressant would be helpful. Talk therapy is often not enough for depressed people. There is a large body of research that has proven that for a majority of depressed people the best course of treatment is a combination of drugs and talk therapy.

So if you have not been on antidepressants then if would probably be an excellent idea for you to work with a specialist in order to begin this. In case you are already on antidepressants, then you clearly need to have your medication evaluated and probably changed.

In order for you to regain your life, you must first have your depression successfully treated.

Best of luck. It will not be a fast recovery as it often takes several weeks for antidepressants to begin to work, but there is an excellent chance for you to feel better if you follow these suggestions.

Michael Shernoff, MSW