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Good Antidepressant Pill-Taking Linked to Better Antiretroviral Pill-Taking

August 2012

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What the Results Mean for You

This study found high rates of adherence to antiretrovirals and antidepressants in HIV-positive U.S. veterans with depression.1 Three quarters of study participants taking antiretrovirals took them on schedule at least 90% of the time, and three quarters of those taking antidepressants took them on schedule at least 90% of the time. Among people prescribed both antiretrovirals and antidepressants, two thirds took both on schedule at least 90% of the time.

Poor antiretroviral adherence (missing doses) can result in treatment failure and can allow HIV to become resistant to the antiretrovirals you're taking. Resistant virus may no longer respond to those antiretrovirals or to other antiretrovirals in the same drug class, and that makes planning another antiretroviral combination more difficult.

People with untreated depression run a high risk of poor antiretroviral adherence when they become too sad or unmotivated to care about their health. That's why it's important for HIV-positive people with depression to talk to their HIV provider about their feelings and to begin treatment for depression if necessary. Depression can be treated with drugs (antidepressants), with counseling (psychotherapy), or with both.

The National Library of Medicine has a useful guide to depression online (see link at reference 2 below). The National Institute of Mental Health (NIMH) has helpful online booklets about depression, including booklets en Español, easy-to-read booklets, and a booklet on depression in people with HIV. To find them, click here. The NIMH lists the following signals of depression:

  • Ongoing sad, anxious, or empty feelings
  • Feeling hopeless
  • Feeling guilty, worthless, or helpless
  • Feeling irritable or restless
  • Loss of interest in activities or hobbies once enjoyable, including sex
  • Feeling tired all the time
  • Difficulty concentrating, remembering details, or making decisions
  • Difficulty falling asleep or staying asleep, or sleeping all the time
  • Overeating or loss of appetite
  • Thoughts of death and suicide or suicide attempts
  • Ongoing aches and pains, headaches, cramps, or digestive problems that do not ease with treatment

Several studies done before this one found that depressed HIV-positive people taking antidepressants had better adherence to antiretrovirals. This new study confirms that people with good adherence to antidepressants are more likely to have good adherence to antiretrovirals. Good adherence to both types of medicine is necessary to control depression and to control HIV.

Among people taking antidepressants, it may be necessary to continue taking these drugs for a while even after feelings of depression disappear. One study showed that fewer than half of people completed a recommended 6-month course of antidepressant therapy.5 Stopping antidepressant therapy before the recommended date can allow symptoms of depression to reappear.

This study identified four factors that affect chances of adherence to antiretrovirals or antidepressants (Figure 1). Older people had better antiretroviral adherence in this study, as in several earlier studies. That could mean older people generally take greater responsibility for their own health than younger people. Even young people with HIV should realize that HIV infection and depression are serious illnesses: HIV cannot be controlled without good antiretroviral adherence, and good adherence to antidepressants is essential if your provider prescribes them.

The study also found that people with less severe HIV symptoms adhered to antiretrovirals better than people with more severe symptoms. The researchers suggest that people who feel better when their HIV symptoms improve may be more motivated to maintain their good health by taking their antiretrovirals as scheduled. People who still have symptoms of HIV infection after they begin treatment should realize that taking antiretrovirals regularly is necessary to control their HIV symptoms.

Unlike some previous studies, this study found that people with more education had worse antiretroviral adherence. The researchers point out that this finding is hard to interpret because almost all study participants had at least a high-school education.

People with an anxiety disorder had better adherence to antidepressants than people without anxiety. The researchers say that could mean that people with anxiety and a tendency to worry may pay more attention to adherence. At the same time, no one wants to have continuing anxiety, and people with ongoing anxiety should talk about it with their provider. There are effective treatments for anxiety disorder.

The researchers point out an important limitation of their study: All study participants were veterans, almost all of them were men, and the average age was older than in most HIV groups in the United States. So findings may not apply to other HIV groups, including women and younger people. But the study did include a high proportion of African-American men with HIV. And the study provides important reminders for everyone with HIV about getting treatment for depression and taking antidepressants and antiretrovirals regularly, according to your provider's instructions.


  1. Bottonari KA, Tripathi SP, Fortney JC, et al. Correlates of antiretroviral and antidepressant adherence among depressed HIV-infected patients. AIDS Patient Care STDS. 2012;26:265-273.
  2. PubMed Health. Major depression.
  3. Pyne JM, Fortney JC, Curran GM, et al. Effectiveness of collaborative care for depression in HIV clinics. Arch Intern Med. 2011;171:23-31.
  4. Fortney JC, Pyne JM, Edlund MJ, et al. A randomized trial of telemedicine-based collaborative care for depression. J Gen Intern Med. 2007;22:1086-1093.
  5. Sawada N, Uchida H, Suzuki T, et al. Persistence and compliance to antidepressant treatment in patients with depression: a chart review. BMC Psychiatry. 2009;9:38.
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This article was provided by The Center for AIDS Information & Advocacy. It is a part of the publication HIV Treatment ALERTS!. Visit CFA's website to find out more about their activities and publications.
See Also
6 Reasons Why People Skip Their HIV Meds
Word on the Street: Advice on Adhering to HIV Treatment
More HIV Treatment Adherence Research

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