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Depression: Chasing the Blues Away

Winter 1999

Have you been feeling sad, blue, lost or despairing? Do the things that usually make you happy and satisfied (like work, family, friends and hobbies) instead leave you cold? Have these feelings lasted more than two weeks? If you answered yes to these questions, you may be suffering from depression and may want to see a psychiatrist for a more thorough screening.

More than one in five women will suffer clinical depression at some point in their life-and people living with HIV are even more susceptible, not just because of the difficult reality of the disease, but also due to the stigma attached to it and the uncertainties around treatment. Some medications can increase the risk of depression as well.

Other symptoms to look for in yourself or someone you care for are over-eating or under-eating, oversleeping or insomnia, crying jags, emotional over-sensitivity, social isolation, low energy and fatigue, a feeling of being 'slowed down' or less motivated than usual, low self esteem, an inability to concentrate and a feeling of lack of pleasure or joy called 'anhedonia.' A common misconception about depression is that you must have suicidal thoughts or plans to be 'really' depressed, and although these are certainly symptoms of depression, many depressive people never experience them at all.

Now for the good news: this is probably the best time ever to be depressed. Medication can help 80% of people with depression, and the other 20% often respond to other treatments such as ECT (electro-convulsive therapy, which is no longer the frightening 'shock' treatment of the past).

New medications are rapidly being developed and more people now than ever before can find some kind of relief.

The state of the art treatment for depression is a combination of medication and a particular type of therapy called 'cognitive-behavioral' therapy. The most commonly used medications are the SSRI's (Prozac, Paxil, Luvox and Zoloft), which work on the brain chemical serotonin, and a drug in another class called Wellbutrin (brupropion). Also commonly used are novel antidepressants called Effexor (venlafaxine), Serzone(nefazodone) and Desyrel (trazodone).

People's reactions to each drug are highly variable and it may take a little time before you find the right one, but most people can find one that relieves depression without odious side effects. If these drugs don't work, you can also try the older drugs called tricyclics: Elavil (amitryptyline), Norpramin (desipramine), or Pamelor (nortriptyline). Another class called MAO Inhibitors is usually used only as a last resort because it requires a special diet to avoid foods which could kill if they interact with the drug.

Unfortunately, some HIV medications also interact with antidepressants. As usual, the worst culprit is Norvir. It can increase the blood levels of SSRI's and tricyclics dramatically and should not be used with Wellbutrin. It also causes very large increases in Serzone and Zoloft levels and moderate increases in Prozac, Paxil, Desyrel, Effexor and all tricyclic levels. There have been reports of cardiac and neurologic problems using Serzone or Prozac with Norvir. Be sure to tell your psychiatrist about every medication you are taking if he or she wishes to prescribe antidepressants, because other HIV medications may have interactions as well.

People often fear medication because they worry about becoming addicted or being stigmatized as mentally ill because they take psychiatric medicine. Antidepressants are not addictive-you don't feel the need to take more and more of them the way you do with drugs like cocaine or heroin, and they don't cause a 'high.' What they do is restore your ability to feel pleasure and not to drown in sadness. And, regarding the stigma: Is it more crazy to leave a condition untreated or take medication which can help? Anyone who denounces antidepressants on principle either hasn't suffered this illness or has no compassion for those who do.

People who have endured more than two bouts of depression are usually recommended to stay on medication indefinitely because research has found that this greatly cuts the chances of recurrence. People in recovery from addictions should not avoid anti-depressants for fear that they are a "slip" or "relapse" -- untreated depression is far more likely to lead to a return to drug abuse than doctor-prescribed non-addictive medications are. 12 Step programs may help some with addictions, but they do not cure everything. Those who tell you that AA or NA opposes antidepressants are ill-informed.

You may also have heard that the SSRI drugs have bad sexual side effects and that they can kill your sex drive or your ability to experience orgasm. But by changing the dose or medication, most people can find something that keeps depression at bay while allowing sexual pleasure.

Recent research on depression in people with HIV has found that, as with other types of depression, combining talk therapy (in this study, group therapy) with medication produces better results than either technique alone. A support group (for people with HIV, or a 12 step group or a depression group like the Mood Disorders Support Group in Manhattan) is probably just as helpful as a professionally led group in most cases here.

If your insurance company or Medicaid or your finances allow you access to talk therapy as well as medication, be sure you see someone who works with cognitive techniques. Freudian, Jungian, insight-oriented therapies have not been found to help depressed people. Cognitive techniques work by helping people to reframe their thoughts and take actions to directly fight the condition. Learning about your childhood may be interesting, but for most people, it doesn't relieve depression. Cognitive therapy isn't fancy or complicated and isn't usually required for long periods of time. In fact, some of the slogans in AA like "One Day at A Time" and "Make a gratitude list," actually refer to cognitive techniques which help fight depression as well as alcoholism.

If you cannot afford cognitive therapy and want to learn some more of these techniques, there are several self-help books available on the topic. One of the best is "Mind Over Mood: A Cognitive Therapy Treatment Manual for Clients" by Dennis Greenberger and Christine Padesky Guilford Press, 1995. It is designed for use with a therapist, but can also be used without support.

Women are more than twice as likely to become depressed as men. It's not clear yet whether this is due to women's hormonal cycle or to the fact that women have typically had less freedom than men. Scientists are just beginning to work out the relationships between sex hormones and the brain chemicals involved in depression. In fact, for post-partum depression, where women usually don't wish to take drugs because they want to nurse, some gynecologists have found that treatment with female hormones can help.

If you are depressed, don't give up hope. There is a lot of help out there and you won't feel this bad forever. The sooner you take action, the sooner your recovery can start.

Copyright ©1999 by People With AIDS Working for Health, Inc. Non-commercial reproduction is strongly encouraged.

This article was provided by PWA Health Group. It is a part of the publication Women's Treatment News.
See Also
Depression and HIV
Feeling Good Again: Mental Healthcare Works!
More on Depression and HIV/AIDS