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HIV Positive and Feeling Sad

Jul 21, 2004

Dear Dr. Horwath, I was diagnosed HIV positive four years ago. While initially distressed, I have learned to accept my situation and live my life with as much fulfillment as possible. Lately however, I have noticed a significant change in my mental health. I find myself profoundly sad and without much hope for the future. I have lots of confidence in my HIV doc, and told him of my condition. He put me on 200 mg of Wellbutrin, but frankly, I'm not experiencing the changes that I had hoped for. I'm presently on Viramune, Abacavir and 3TC, and have an undetectable viral load and a CD4 count of about 380. My question is this: Are these particular medications, in your opinion, associated with depression, or if not, is there another drug, apart from Wellbutrin that might help my emotional state of mind. I am a teacher and presently work fulltime - and thankfully, holidays are just around the corner. I'd appreciate any advice you can offer. Thank you.

Response from Dr. Horwath

You are sufffering from clinical depression, for which we have excellent treatment. The antiretroviral medications that you are taking do not cause depression, although depression has been reported as a side effect of efavirenz (Sustiva).

Your doctor started Wellbutrin, which is an effective antidepressant, but you are on a sub-therapeutic dose. You are likely to get a much better response by gradually increasing the dose to Wellbutrin SR 450 mg/day. The SR refers to slow-release, which is a formulation that only needs to be taken once/day.

If Wellbutrin at the higher dose is not effective, there are many more antidepressants which can help (e.g. Zoloft, Lexapro, Effexor, etc.). You may want to seek a referral to a psychiatrist with experience in treating depression. Psychotherapy is also extremely helpful in conjunction with antidepressant medication.

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