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Depression worsens with Treatment

May 3, 2005

In January 2003 I began treatment for HIV related depression. I had been diagnosis with AIDS in October of 2002 and began a regiment of Sustiva & Combivir (this has changed to Sustiva and Trizivir). I take 300mg of Effexor XR and 300mg of Wellbutrin daily as well as see a therapist 2 to 3 time monthly. Today, my therapist gave me a test that I had completed when I first started seeing him in January of 2003. The test is designed to measure the level of depression. In January of 2003 I scored a 17, today (over two years later) I scored a 39. My question to you is, I have done all of the right things to treat my depression, medication, therapy, watched my diet & try to exercise but I am more depressed now than when I first started treatment! What other types of treatment can I try?

Response from Dr. Horwath

Although you have been treated for depression with an effective medication regimen, the lack of response suggests the need to look for other causes of nonresponse. The most obvious one is the fact that you are taking Sustiva. Depression is a common adverse effect due to treatment with Sustiva. A recently published article on the long-term effects of Sustiva indicated that the psychiatric effects of Sustiva (like depression) can persist for months in some patients. You should speak to your HIV doctor to see if there are any other appropriate alternative antiretroviral drugs(perhaps another NNRTI, such as nevirapine), that you might be able to switch to.

If this is not an option, then get a consultation from a psychiatrist with expertise in treating depression in people with HIV infection.

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