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Depressed, ovewhelmed. and unsure of the cause

Sep 8, 2017

I found out I was HIV + 3 years ago. It was a drunken one-night stand, my only one in my life. I was unlucky. Apparently there's a 1 in 90 chance of catching it this way. Maybe I should pick some lottery numbers? Anyway, this happened a month after my best friend (and ex boyfriend) got sick with some bad allergy and had to be hospitalized. He got worse and then started having terrible fevers and got a rash. He told everyone he had dengue. He died 2 months later from AIDS and TB and obviously I found out he'd had HIV for the whole 7 years I knew him and probably a very much longer time before that. I not only had to grieve, but also to deal with my own terminal diagnosis, also lose my best friend, my only true friend, and then find out he had lied to me the whole time. Fun times.

So, I'm in South East Asia and the general concensus is not to start ARV medication until the last possible minute as it can destroy you mentally (apparently). My CD4 count recently sank below 180 so I clinically had AIDS for a short time. That wasn't much fun as I knew nothing about it at the time (had buried my head in the sand while trying to deal with grief and drug and alcohol addictions). I'm now taking Trioday and I'm feeling generally better a month down the line, but I have been getting searing headaches, I am completely lacking in energy, I can't sleep properly and I am seriously depressed. Not suicidal depressed, just kind of hating the world and everyone in it (including myself), and I don't dare go out much except to work and to buy food as all the people I have met, and continue to meet are really bad. I don't know what I'm asking here but is there any way of knowing what is causing my depression? Could it be the meds? The life stuff? How do you get over it? I do exercise. I can't talk to anyone because I don't trust anyone. I told my mum what was going on some time back and she proceeded to tell my whole family. My dad is dead. He sexually abused me, and my brother was physically and mentally abusive for my whole life and I came to Asia to escape all that. On my first day I was mugged and thrown off a building where I ended up in hospital for 3 weeks. I met by best friend and ex some time after I recovered from my 8 broken ribs and punctured lung. My best friend sold me a lie for 7 years and put me at risk countless times. I had other friends and they cheated me for money. I'm kind of done with the world but I'm not brave enough to kill myself so for now I'm just existing. Not drinking or smoking. I am doing all the right things. I just don't find any enjoyment from life at all any more. It's like I'm dead to the world and I'm just an outsider looking in and wondering why I can't just have a normal life. I don't need a counsellor because they could never understand what I've been through and talking doesn't change the past. I don't want to take anti-depressants because honestly I'm on enough pills at the moment with all these vitamins and organ boosting things and I don't want to completely lose it. Do you have any advice? Anything at all? Thanks in advance.

Response from Dr. Fawcett

Hi and thanks for writing. I'm sorry to hear about all you've been through. There's a lot of grief and trauma there, so it's not really surprising that you are feeling very depressed.

I'm glad to hear that you are on medications. We know that the sooner one starts the less risk there is for complications down the line. The medication should help your HIV.

Now about the rest. Sadness and grief is a normal response given all you've been through. When we have those feelings and suppress them with addictive behaviors, however, they don't get released and the symptoms will worsen. This is a very common reaction to the news that one is HIV positive, especially in someone with a history of trauma. The drinking and drugging, along with the depression, will only worsen your overall sense of dread, anger, and isolation.

Here's what I recommend:

1. Stay clean and sober. I'm so glad to hear you are not drinking or drugging at the present time. This is really critical not only for your mental health but for possible interaction with your HIV medications. There are support groups like Alcoholics Anonymous and Narcotics Anonymous Anonymous all over the world. It's nearly impossible to stay clean and sober without support. I understand that you have trust issues but your cannot do this alone.

2. Speaking of alone, you need to find some support. One of the killer co-factors in HIV is isolation and you need to find a solution for that, even if it means coming home from Asia. Being socially connected is essential to your physical and emotional well-being.

3. Your history of trauma, whether at the hands of your family, your terrible mugging, and even the betrayal of your boyfriend will complicate your feelings and contribute to your emotional distress. I believe that this trauma needs to be addressed to totally eliminate your depression, and that requires professional intervention.

4. Antidepressants work and the most common (called SSRIs) do not significantly interfere with your medications. Please consider speaking with your doctor about them - they will help. Given your mood, I think an antidepressant is more important than any vitamin.

5. I'm glad to hear you don't have active suicidal thoughts. If you ever do begin to think about it or give serious thought to a plan you must get help immediately. Don't hesitate.

6. Finally, it's just not true that a counselor (at least not every counselor) wouldn't understand your experience. I am a counselor and I have had most of your experiences. Your location may limit who you can find but I assure you that a mental health professional doesn't need to have lived your experience to understand them and help you. Don't unnecessarily limit your options.

You are in a tough spot and I understand how overwhelming this all must be but please consider taking the steps I've outlined.

All the very best,

David



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