Depression, Women and HIV
April 7, 2015
Studies show that there is a direct connection between depression and poorer health for those living with HIV. Specifically, women living with HIV who are depressed seek HIV care less often, have more trouble sticking with their HIV drug regimens, and have more rapid disease progression. If you are experiencing symptoms of depression, you may miss drug doses, take the wrong dose, or take the dose at the wrong time. Not taking your HIV drugs regularly can lead to the development of resistance, which makes HIV drugs less effective at fighting the virus. This can cause your CD4 cells to go down and/or your viral load to go up.
Even among women living with HIV who have similar CD4 counts and viral loads, being depressed can double the likelihood of dying compared to having few or no symptoms of depression. One study showed that the risk of death was cut in half for those women who made contact with a mental health provider. It is important that depression be diagnosed and treated as quickly as possible to avoid serious problems.
The good news is that depression is treatable. Treatments include psychotherapy, social support, medication, alternative therapies, or any combination of these. While it is true that depression can get better on its own, this can take months or even years. Treatment will likely shorten the time it takes for you to feel better and may help you stay on your HIV drugs. It also may keep you from losing a job, a relationship, or even your life.
Various mental health professionals can provide psychotherapy, also known as "talk therapy" or personal counseling. Psychotherapy involves talking to a trained professional about what you are experiencing. The therapist provides support and helps you to understand what is troubling you. While most psychotherapy occurs one-on-one, group therapy is also helpful for some people.
In the US, mental health professionals who provide psychotherapy include:
- Social workers
- Marriage and family therapists
- Mental Health Counselors
It may also be helpful to seek the support of other HIV+ women through support groups or peer counseling (please visit our online blog for women living with HIV, A Girl Like Me). Social support from friends and family has been found to help people living with HIV avoid depression or cope better with it. Connecting with others can help you not feel lonely and isolated. Friends and family can also provide emotional support, which is very important for people living with a serious illness like HIV. Members of a social support network can help with chores like shopping or housework and act as caregivers if you get sick.
Antidepressant medications are often prescribed for depression or anxiety and have been shown to help decrease symptoms for some people. Care should be used when taking antidepressant medications with HIV drugs. Many of the antidepressant and anti-anxiety drugs can interact with some HIV drugs. It is important to talk to your health care provider before starting any new medications.
Generally, the safest type of antidepressants for use with HIV drugs is selective serotonin re-uptake inhibitors or SSRIs, such as Celexa (citalopram), Lexapro (escitalopram), Luvox (fluvoxamine), Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline). A popular herbal antidepressant called St. John's Wort should not be taken, as it affects the immune system and interacts with many HIV drugs.
Meditation, massage, yoga, breathing, and relaxation exercises are all alternative therapies that may help you feel better. Acupuncture and acupressure therapies may help reduce stress and improve your mood. Mindfulness techniques may help you get back in touch with what makes life worth living and avoid going into downward mood spirals. Some of them have even been combined with traditional psychotherapy and shown to be very effective (e.g., mindfulness-based cognitive therapy). Good nutrition and physical activity are beneficial, no matter which treatments you choose.
It is important to talk to your health care provider about depression, especially if you are experiencing symptoms or having trouble sticking to your HIV drug regimen. If you are suffering from symptoms of depression, ask for a referral to see a mental health care provider. Mental health care (including psychotherapy, social support, medication, and alternative therapies) can not only improve your adherence to HIV drugs, but also improve your health and quality of life.
Some people do not believe in the value of mental health treatment. You or those you love may have heard that people who see therapists ("shrinks") or take antidepressants are "crazy," or weak. Try not to let these judgments keep you from getting treatment that will make you feel and live better. When we experience physical problems, it is best to get treatment. If someone breaks her leg, we encourage her to see a health care provider to get the leg checked and treated so it heals properly. Similarly, when we experience emotional difficulty, there is no need to suffer when effective treatment is available.
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