Hi Dr. Horwath, I'm a healthy 41 year old male, on successful treatment with sustiva/truvada for almost 2 years. (undetectable, 790, 32%) I have a good network of well-informed friends here in NYC and a therapist that I can speak to when I need to. I find, however, that talking simply isn't enough to alleviate the anger/shame I have with myself for the situation I put myself in, the rather limited options for a long-term partner and the ever-present, albeit underlying anxiety that sometime in the future, my drugs could begin to fail and I could face any of the dreaded physical issues one reads about on sites such as this one. Would an antidepressant help to take the the edge off some of these negative feelings? Which drug do you find seems to have the least troublesome side-effect profile? (sexual, sedating, jitteriness) Thanks.

Feelings of anger and shame are not typically responsive to antidepressant medication. I certainly wouldn't rule out that they might be helpful, but feelings such as this are very closely linked to your experience of HIV infection and may be better approcached through another therapy. Cognitive therapy, in my own experience, is often quite helpful in working with recurrent self-critical thoughts. Similarly, shame is often accompanied by thoughts of falling short of some internal ego ideal, and cognitive therapy can sometimes help to temper critical demands of a puinitive superego.