Having "The Blues" for a day or two is some-thing we all feel occasionally. Depression is different. Depression can last weeks or months, or even years. It can change your body chemistry and, left untreated, can worsen or even cause other illnesses.

Many things can cause depression, including some HIV drugs (particularly efavirenz/Sustiva), medications for hepatitis C, vitamin deficiency and hormonal irregularities. Social factors and life stressors, like money problems or loneliness, can also contribute to depression.

Numerous studies have shown that HIV-positive women experience higher rates of depression than HIV-negative women and men. This is probably partly due to hormonal changes and the increased burden and isolation experienced by many women living with HIV.

Depression makes you feel bad about yourself and your environment, and it can make you feel hopeless about the future. Fortunately, depression usually responds well to treatment.

Signs of Depression

Recognizing signs of depression is the first step to combating it. Many people associate prolonged sadness and thoughts of suicide as classic signs of depression. While some experience these symptoms, not everybody who is depressed does. Other common signs include fatigue and/or insomnia. Loss of appetite and/or sex drive are also signs, as is losing interest in family, friends, work and life.

Treating Depression

Talking, using medications (anti-depressants) and making lifestyle changes (like exercise and nutrition) are ways to treat depression. An approach that combines these strategies works better than choosing only one.

Connecting with Others

Talking is an essential part of beating depression. Talking to a therapist can be very effective. Increasingly, there are therapists who specialize in working with people living with HIV. Sometimes your doctor, local AIDS service organization, or support group can refer you to such a therapist. Choosing one you feel comfortable with may take time. Health insurance, as through private insurance or Medicaid, sometimes covers these expenses.

Support groups are sometimes just as effective as talking with a professional therapist, and they're often free. Many experts recommend that all positive people seek some form of support. Few, if any of us, were taught all the skills needed to cope with a life-threatening illness. Also, many books can be bought or checked out at your local library with useful information on overcoming depression.

Anti-Depressants

Anti-depressants have proven to make a big difference in the lives of many who suffer depression. These pills can be taken short- or long-term, depending on your need. A commonly used class of anti-depressants is called SSRIs (serotonin specific re-uptake inhibitors). These work on the brain chemical, serotonin. SSRIs like paroxetine (Paxil), sertraline (Zoloft) and fluoxetine (Prozac) are widely used in treating of HIV-related depression.

Other types of anti-depressants, like brupropion (Wellbutrin), and new treatments are in development. People respond to anti-depressants differently, and it might take time to find one that works well for you. Anti-depressants work best when coupled with some sort of talk therapy, be it with a trained professional or a support group.

An important consideration when talking to your doctor about choosing an anti-depressant is the potential for drug interactions, especially if you take HIV drugs. For example, ritonavir (Norvir) should not be used with brupropion: it can increase blood levels of SSRIs. Also, some anti-depressants increase or decrease blood levels of oral birth control; dose modifications of oral contraceptives may be necessary.

Again, talk to your doctor or pharmacist about possible drug interactions with anti-depressants and other therapies you take. (See Project Inform's "Drug Interactions Fact Sheet" for more information.)

Despite the success of anti-depressant therapies, not all people benefit from them nor do the effects always last. It's common for people to start with one anti-depressant and then either switch to another or add others to their daily regimens. Some end up using two to four anti-depressants at the same time. Even then, the drugs can fail, especially when a person ignores her other forms of support.

Herbal Remedies

The herbal treatment most often used in hopes of combating depression is St. John's Wort. Caution is advised when using this herb for several reasons. First and foremost, the most recent controlled clinical study found little or no effectiveness when comparing St. John's Wort to a placebo (harmless sugar pill). Even its supporters claim it may only work in mild forms of depression.

The herb also has a significant interaction with indinavir (Crixivan). Indinavir blood levels were greatly decreased when they were used together, greatly reducing indinavir's anti-HIV activity. This can lead to developing resistance to indinavir.

St. John's Wort is also likely to greatly decrease blood levels of other protease inhibitors as well as non-nucleoside reverse transcriptase inhibitors. People who take these drugs are advised not to use St. John's Wort. Individuals who use complementary therapies should always discuss possible interactions with their doctors and pharmacists.

A final reason for using caution is because all herbal remedies are completely unregulated -- there is no way of really knowing how much herb is actually present in a supplement, or even its quality. If you try St. John's Wort look for the active ingredients, hypericum at 0.3% and hyperforin at 6%, and seek advice as to which are the most reliable brands. Some nutritionists recommend trying 300 milligrams three times a day, but even this figure is uncertain. The kind of studies needed to determine proper dosing of a drug have not been done with St. John's Wort.

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