Hi, so I've been HIV positive for roughly four years now, and over that time I seem to be losing my grip on reality (whatever that is). I'm fairly certain it's not resultant from viral activity, but more prone to say that since my diagnosis, I've not quite been able to pull myself back together and it's been a slow but steady downward spiral. Since onset, I've seen three psychotherapists, one for the last two years or so.

To preface this: I have no history of drug or alcohol dependency. I'm 28, male, vegan, in good physical shape and have no history of any physiological disorders (save one, as mentioned below). Last CD4 and VL indicated a substantial decline in my immune function (~430->330 CD4) (~8,000->70,000 VL); results were three months apart. I've not yet taken any AIDS medications (as they've not yet been recommended).

My background: I have had varying degrees of depression (most acutely 'major' depression) and anxiety disorders (GAD, SAD) most of my life, and have been on many different medications. More recently in the last few months I've been deemed variably bipolar-II and bipolar-III. I'm pretty much at my wits end. I've been on anti-depressants and so-called mood stabilizers (anti-psychotics) for more than 13 years (many different regimens, many different psychiatrists/G.P.s) and I've since given up on psychopharmacology (besides a self-prescribed 100mg 5-htp pill before bed) as it seems to make me more erratic/hypomanic/confused or sloth-like, comatose and virtually without affect. Since diagnosis, I've been prone to extreme/violent anger outbreaks, which can last for an entire day or end as quickly as they start. I'm often confused as to what's being said, or conversely how to articulate because I have a hard time focusing, subsequently remembering, and keeping my thoughts straight. I've become overly paranoid to the point where friends make fun of my "agents under the bed" (their taunts are hyperbolic, but I am extremely paranoid) and I find it nearly impossible to trust anyone. I vacillate wildly between the suicide hotline and being well enough for the most superficial of interactions. Everything and everybody tend to seem hollow, and there are times where I don't feel quite real, nor do I often recognize those around me as separate, feeling, thinking entities (and hence, hollow); and without much notice of the morbidness, I often get excited by the notion of eventually dying, as if it were my homecoming (this is different from feeling suicidal which I associate normally with deep despair of which I am cognizant). Emotions are practically alien to me, both expressing and interpreting. I storm away from people supposedly trying to help me, sometimes making huge scenes in public and don't evidence any concern for hurting their feelings (remorse is felt after I've 'come down'). During these episodes it is almost as if I'm overthrown by an utterly unhinged lunacy that parks my non-episodic self in the 'passenger seat'. I don't realize how crazy I'm being until I struggle to bring the intellect back online, and even then its recognition is contingent. My G.P. recently ordered an MRI (for the unrelated issue of a not-too-recent history of cluster headaches) and the neurologist found no structural defects. I'm running through intensive psychological testing designed to look at potential memory problems and (at my own behest) possible learning disabilities, but so far they haven't indicated much. I'm writing this on a good day when I am collected enough to know I have a serious problem and have the mental capacity to express thoroughly my concerns. I fear that I am losing my mind. Categorical diagnoses seem moot as I variably have 'symptoms' of just about everything. I've lost a lot of friends in the last four years at least in part from my 'craziness' and haven't made many new ones. The ones I have left are very concerned and constantly push me to new help resources, but I am equally concerned that they won't be able to endure this much longer, which would be devastating as my friends are my only family. I'm tired of feeling like this and I'm tired of not being socially functional. Whereas prior to diagnosis I was prone to depression and varying degree of social anxiety (nominally 90% stable), now my proverbial rocker is often nowhere to be found. I can't tell if this is an existential crisis turned psychotic or if I'm just dreaming all of this (which fuels my sometimes troubling excitement of an end of life). There may not be a correlation between the HIV as a viral agent and my story here, but there seems an almost undeniable aberrant psychological effect. I'm aware that this plea already describes an array of actions that may seem like I'm 'on the right track' to examining my issues, but my world is quickly crumbling and I can clearly use all the help I can get. Thanks... Empty and Lonely

You have painted a very complex picture and it is not possible for me to fully evaluate your condition. However, it is clear that you are having substantial emotional and psychological problems. The MRI and neuropsychological testing do not point toward a neurological cause.

There are cases described of mood disorders similar to bipolar disorder that have an onset after HIV infection in people who had no prior history of mood disorder. Your own history is more complex because you had a past history of depression and anxiety.

You mentioned several psychotherapists and pharmacological treatment by GPs. At this point, I would recommend an evaluation by an experienced psychiatrist (experienced with mood disorders and preferably also with knowledge of HIV). a good psychiatrist can better evaluate you and make treatment recommendations that may not have been considered in the past. You do not need to be in a "downward spiral." There are excellent treatments for conditions such as yours and your life should improve significantly with effective treatment.