Depression has been the subject of many conversations with my incarcerated peers over the years but only as a feeling and little else. After researching this issue just recently, I have found it to be a multi-dimensional and often misunderstood issue. It is indeed a condition or syndrome that has symptoms of its own. In prison, it is very easy to write off feelings of sadness and loneliness as appropriate and natural that have been created by our immediate surroundings of the prison setting. Having to deal with HIV disease in here as well, makes it that much easier to simply write off those feelings.
The fact is that HIV or not, in or out of prison, depression disorder is one of the most undiagnosed, untreated conditions in existence. Left untreated, it can affect our lives in many negative and harmful ways. Among these are a lack of adherence to our HAART (highly active anti-retroviral therapy) cocktails, substance abuse, and even a lack of concern toward safe sex. I hope that the following paragraphs will shed some light on these and other depression related issues that we must face on a daily basis.
Depression, as mentioned earlier, isn't simply about being in a "bad" mood. It is a disorder or syndrome. The most recognized of its symptoms are feelings of extreme sadness, worry and anxiety. These are also cognitive symptoms (relating to perception, learning and reasoning) such as difficulty with concentration and memory, and physical symptoms such as interruption in sleep patterns or decreased tolerance for pain.
The actual cause of depression is not known but we do know that it is related to faulty brain hormones that are made by and for the brain itself. These hormones are neurotransmitters and are mostly made up of seratonin and dopamine (feel good hormones). Because their production is being interrupted, dysfunction is the result. As boring as this might be to you the reader, it is important to understand the common physiological causes of depression.
Before discussing treatment options, it is important to understand who is at risk for depression disorder. Obviously the first of these would be those with a family history of depression disorder. Also at risk are those with a family history of substance abuse or those with a childhood with significant emotional trauma. If you are like me, just check off every single one of these.
Much of the reason depression syndrome goes untreated and undiagnosed so frequently is because depression mimics so many other conditions. For instance, low testosterone, vitamin B12 deficiency and sleep pattern interruption can all be attributed to HIV and therefore may not prompt an individual to be screened for depression related disorders. Bouts with extreme sadness, anxiety and stress may all be considered normal responses to prison, and in particular, prison with HIV, but may in fact be the result of an underlying and undiagnosed case of depression disorder.
If you have any of the symptoms mentioned here, and/or you find yourself in one of the high-risk categories that I discussed earlier, you should think about flying a kite to one of the mental health professionals in you facility. Standard questionnaires such as the Yong Self-Rating Depression Scale or the Hamilton Depression Scale are generally used and are successful because they result in very few false negative diagnoses. They are also very valuable to mental health professionals because they not only determine that a depression disorder exists, but they also indicate the degree of severity of that disorder. It is worth repeating to remind us that if such a disorder is present, it will not simply disappear. If it goes untreated in an environment such as prison, it could evolve into a major medial problem.
There are several effective ways in which to treat "clinical depression disorder." Before deciding what is best for you, discuss them all with the mental health staff at length. Because of the potentially confusing cross-over symptoms we talked about earlier, it is very important to make sure there are open lines of communications between mental health professionals and any medical staff treating you for HIV disease.
Treatment options include individual or group therapy (it can be comforting to know that there are many others who feel the way you do). There are many psychosocial issues involved with HIV and prison. Counseling, whether group or individual, can be a part of an extremely effective treatment plan. There are also several effective drugs that have found great success for depression disorder treatment plans. Just as protease class drugs were proven so effective in treating HIV disease, anti-depressants can make depression disorder a chronic manageable condition. Because there is such a wide spectrum of different anti-depressant drugs available, physicians have found that different drugs can act on specific brain hormones in different ways, giving them a variety of solutions to the sometimes complicated problems of depression disorders. It's worth mentioning that there may be anti-depressants that should not be taken with certain HIV medications. Once again, be certain that medical as well as mental health providers are aware of any combination of drugs that very well may be problematic in your particular situation.
With the incredible success of anti HIV drugs our disease has indeed become manageable and in many ways less threatening to us. In order to better enjoy the quality of like these drugs have given us, we need to become familiar with, and find the best solutions for those conditions such as depression disorder that often accompany HIV disease. As both effective counseling and medication resources are available, it is critical that these therapies be used to the greatest extent possible by those inmates who might benefit to most from them.
The author welcomes and encourages your comments and suggestions about this and his other articles featured in this newsletter. You may direct your correspondence to:
Walter D. Meyers #69486
Colorado Territorial Correctional Facility
Unit 7, Box 1010
Canon City, CO 80215-1010
Back to the Spring 2004 issue of Positives for Positives.