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Women, HIV, and Depression

By Sandra K. Trisdale, Ph.D.

Spring 1999

Before you decide that you don't need to read this article, did you know that:

For years, we have been focusing on physical health in HIV. But mental health is a key factor in quality of life, and in survival itself. Depression can kill you -- or make you wish you were dead.


Having the Blues

Clinical depression doesn't mean "having the blues" for a day or two and then feeling better. Clinical depression causes real changes in your body chemistry and in your brain. Depression can last weeks or months at a time, or even years if it is not treated.

Why is depression such a problem for women living with HIV? People with HIV are more vulnerable to depression; so are women. Certain HIV medications can contribute to mood changes or depression, particularly protease inhibitors and efavirenz (Sustiva). If you're low on certain vitamins, such as B-12, or certain hormones, such as testosterone (yes, women need testosterone, too!), you will end up with depression.


Warning Signs

When you're positive, it's normal to blame any changes in your body on HIV. If you're tired all the time, if you have no energy or motivation, if you've lost interest in sex, if you're having insomnia, if you have no appetite, it's easy to think that it's due to HIV. But these can also be signs of clinical depression.

What are other warning signs of depression? Look for the following: loss of interest or pleasure in activities. Irritability or losing your temper easily. Social withdrawal, especially when you're screening your calls or avoiding friends and family. Crying a lot or feeling like you want to cry but can't anymore. Depression can even cause concentration and memory problems that can be mistaken for dementia.

"Mental health is a key factor in quality of life, and in survival itself. Depression can kill you -- or make you wish you were dead."

The bad news about depression is how bad it makes you feel. Depression makes you feel bad about yourself and your environment, as well as hopeless about the future. The good news about depression is that it usually responds to treatment. Possible treatments include psychotherapy, Western medications, and alternative treatments.


Nutrition

Remember that nutrition is important no matter what other options you choose. In particular, when you're HIV+, you may need extra B-12. This is often not absorbed well into the stomach, so look for injections, sublingual (under the tongue), or oral sprays. Exercise is very effective in treating depression, too. And don't forget about sunlight! The worst thing you can do when you're depressed is stay inside all day long, especially for days at a time. Get out and walk around outside for ten minutes, even if you haven't had a shower and you just throw on some grubby clothes to do it.

The best herbal treatment known for depression is St. John's Wort. However, there are some brands that have no active ingredients. If you decide to try this, look for hypericum at 0.3% and hyperforin at 6%; try 300 milligrams three times a day.


Antidepressants

Not all Western antidepressants are the same. Be careful if you are taking ritonavir (Norvir), which interacts with many antidepressants! Also, the tricyclic antidepressants (such as amitriptyline/Elavil, desipramine/Norpramin, imipramine/Tofranil, nortriptyline/Pamelor) can have interactions with HIV medications as well as numerous side effects. Many HIV specialists prefer a class of medications called SSRIs (serotonin specific re-uptake inhibitors). SSRIs such as Paxil, Zoloft, and Celexa are widely used in the treatment of depression in HIV, as is an "atypical" antidepressant known as Serzone.

Of course, it's a pain to think about taking one or two more pills a day. But in many cases, they can make a huge difference in quality of life. Best of all, you don't necessarily have to stay on them.


The Key

Psychotherapy is very effective in treating depression. If you live in an urban area check for therapists who specialize in working with people with HIV, your local AIDS Service Organization may be able to help you. If you have to work with a therapist who is not HIV savvy, insist that she/he does the homework to find out more about the issues people with HIV have to deal with. If you live in a rural area or don't have much access to care, try to do as much as you can on your own and if possible attend some of the HIV conferences aimed at women; frequently scholarships are available for women who are HIV+.

The key when you're depressed is the same as the key when you're HIV+: educate yourself and take action to get the treatments you need!


Back to the Women Alive Spring 1999 Contents Page.




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