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sustiva and previous history of depression

Mar 20, 2006

Recently infected (August 2005), first numbers, at the 6-month point, are good I think: CD4 757, CD% 38, VL... below 400 (the detectability threshold for this test, they don't order the ultrasensitive test for early first labs I was told). So I don't think I'm a candidate for treatment just yet I suppose.

But then again, who knows. It seems that most initial med regimens these days are either Sustiva- or Kaletra-based. I have a history of chronic depression, first episode at 10, episodes every five years or so, under control, currently on Effexor 225 and Buspar 30. My question is: is Sustiva definitely/definitively contraindicated for people with a past history of depression? I have to admit, the list of CNS side-effects scares me. And the potential for lipodystrophy with a PI-based regimen isn't all that attractive either. So, in your experience, what do you recommend as first-line treatment to people with a history of depresion?


Response from Dr. Horwath

As you know, some people who take Sustiva experience side effects such as insomnia, vivid dreams, and depression. We don't know who is more likely to experience these effects ahead of time. We do know that for most (but not all) people who experience such side effects, they tend to occur early in treatment (first few months) and are transient.

The fact that you are currently taking effective antidepressant medications should protect you. However, there is no good way to predict. I do not believe that Sustiva is contraindicated for someone like yourself, with a history of depression. However, you should weigh the risks and benefits of both treatment options and discuss this with your doctor. Fortunately, you do not need to start treatment now, and you have time to discuss and weigh the options.

HIV+ and living with teenager with behavioral problems
Mind over matter ? reality?

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