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Tired ALL the time

Jan 31, 2001

Dear Mr. Shernoff: I am a 38yr old woman who has been positive for about 5 years. My problem is that I am physically tired all the time. It doesn't seem to matter if I sleep 3 hours or 15 hours. I'm still tired. My doctor has ruled out just about everything that could be physically wrong with me. I have read that depression can make a person feel tired all the time. Is this true? Also, my insurance does not cover counseling and I don't have a lot of extra money. Do you have any tips on how to interview a counselor to make sure they are sensitive about HIV? I live in a pretty conservative area in California that isn't close to a big city. As bad as I feel, I'm not looking forward to spending precious money for a meeting with an insensitive jerk of a therapist. Any help or information would be appreciated.

Response from Mr. Shernoff

Depression can most defintely cause the kind of chronic tiredness that you describe. The best way to find a psychiatrist who will be an HIV expert is to ask your primary care MD to refer you to a colleague that he or she knows, respects and is certain has worked with alot of HIV+ people. If your primary care doctor does not know of an MD psychopharmacologist (this is a psychiatrist who is a specialist in prescribing psychiatric drugs) then call the nearest AIDS service organization and ask them for a referral.

While it would be best for you to have both talk therapy and antidepressant medications, since your insurance will not pay for this, most likely it will pay for medication consultations with an MD psychiatrist. If your insurance will not even pay for this, once you have begun the medication and know that you are feeling better, your primary care doctor can always write the refills for you.

Best of luck. You are another example of why I refer to managed care as either "mismanaged care" or "mangled care."

Michael Shernoff, MSW

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