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Medication options for Depression/Anxiety?

Feb 6, 2014


I am 23 years old, and I have been positive for 5 years. I used to take Atripla, but experienced the rare negative side effects associated with it, and I'm now on Stribild. I have blood tests regularly to keep up with my health, and nothing indicates that there is anything wrong according to blood work.

However, I am constantly fatigued. The feeling of constantly being weak and tired is taking its toll on me. I feel sore in my muscles. I never feel like I can do anything, even if I wanted to. I get enough rest, I eat well enough. I'm active because I have to be to go about with my daily routine.

I do have depression and anxiety. The issue I have with medications for depression is that I don't think the treatment is being/has been as effective as it should be. I never felt a positive change. I've tried Prozac, Zoloft, Citalopram, Wellbutrin and Lexapro. I've taken them for the periods of time in which a change should have taken place. For anxiety I have taken Clonazepam and Hydroxyzine, but I feel I can't take those because they are too sedative, which is counter productive when I'm trying to not be fatigued. In any case, no medication has suppressed the chronic fatigue and weakness I experience.

I know that apathy is related to depression, and that has been an increasing issue as well. I don't want this to become a downhill issue where I feel suicide is an option. I've approached my doctors for different treatment methods, but the options they give me are try prozac again, offer a medication that is far too similar to one already taken, etc. They're a great team of doctors, but I don't feel they're really identifying a combination of medicine, and therapy that has been useful yet.

My question would be, is there medication(s) I could discuss with them that would be more productive for my health? Is there one I should pitch to them, and see if they think it is right for me?

Response from Dr. Fawcett

Thanks for writing. Your ability to clearly articulate your concerns as well as knowing your history various medications is an asset. I don't have an easy answer for you. You don't mention psychotherapy. One general principal that has been replicated numerous times in the literature is that a combination of psychotherapy and medication produces the best outcomes. If you haven't tried that I would definitely do so in addition to any medication regimen.

Finding an effective medication is sometimes trial and error until you find the one that has results. This is frustrating for both the patient and the provider. You mention your doctors but don't say if a psychiatrist is on board. Be certain a psychiatrist is helping you with these decisions, and preferably someone familiar with HIV. I know many people that get a second neuropsychiatric opinion from such a specialist who may be at a university and who can provide more options.

Finally, in addition to psychotherapy, I feel that other types of "connectedness" can have very positive results. I realize that your energy levels are a concern but I think that attending a support group or some other gathering of solution-based people will be very effective for you.

Good luck,


Comment from reader: Don`t wait for an arv combo to destroy your mind: switch!
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