Anyone, anywhere, of any age, sex, and ethnicity, living with any possible set of circumstances you can imagine, can become depressed. This includes people who would themselves readily say that their life looks perfect "on paper". It is, however, hardly surprising that people facing objectively challenging situations are often more likely to be diagnosed with depression than others. This includes people living with chronic pain and serious medical conditions.
Various studies have looked into the reasons behind this increased risk of depression, and the possible causes they identified will be familiar to many HIV-positive people:
- Worries about health and lifespan
- A decreased ability to work and earn a living
- Social isolation
- Progressive physical symptoms
- Suffering side effects from antiretroviral therapy
- Poor sleep quality
Depression is a challenge for every single person living with it, but there are unique concerns when it comes to depression in HIV-positive people. Research has shown that HIV+ people who are also depressed are less likely to stick to their prescribed medication, which can have serious health consequences. We further know that depression alters the way in which the immune system functions, and that means that being depressed leave a dangerous mark on the physical health of people with HIV.
How can you improve your life if you are a depressed person living with HIV?
1. Seek medical attention for your depression!
Effective treatment for your depression depends on receiving the correct diagnosis — and that starts with seeking medical attention for your depression. Taking this step can be extremely hard for anyone suffering from depression, but it may be especially hard for people living with HIV, who may — depending on where they live — be worried that the healthcare provider who can help them treat their depression may instead discriminate against them because of their status.
Researching HIV-friendly doctors and psychologists may be helpful for you, and this is something your local association of HIV-positive people may be able to help you with. The internet, too, can be a great tool.
2. Access treatment for depression
The same treatments that can benefit any person suffering from depression also help HIV+ people with depression, although the American Psychiatric Association notes that people with HIV who are taking medications for depression should be closely monitored for possible drug interactions.
The APA particularly suggests that clinicians consider the following treatments:
- SSRI antidepressants, bupropion (Wellbutrin), venlafaxine (Effexor), trazodone (Desyrel), and tricyclic antodepressants. The fact that tricyclic antidepressants are not unlikely to cause weight gain is usually seen as a con, but this can be helpful in people living with HIV or AIDS. TCAs further alleviate neuropathic pain, which isn't rare in HIV+ people.
- Hormonal treatments such as testosterone and DHEA, which can fight fatigue and a lowered libido.
- Electroconvulsive therapy, for patients who cannot tolerate antidepressant medication or who are psychotic or suicidal.
- Talk therapy, which can especially help people whose depression was triggered by changed life experiences resulting from a HIV diagnosis.
3. See if your HIV medication can be changed
A number of medications HIV patients may be prescribed can have depression as a side effect. These include but are not limited to steroids, interferons, interleukins, efavirenz (Sustiva), and zidovudine (Retrovir, AZT). Sometimes, there will not be an alternative treatment — but sometimes there will be. If you are taking a drug that is known to have the potential to induce depression, talk to your doctor about alternatives that may be available to you.
4. Find a community of people who understand you
No matter what long-term health condition we're talking about, the suggestion to join a "support group" of other people who have the same condition will always come up. Various studies have looked into the benefits of support groups and group therapy for people living with HIV. Though we've got to be honest and report that the these interventions weren't conclusively proven to have a positive effect on the mental state of most depressed people living with HIV, you may still find you really benefit from a support group.
Why? For several reasons.
- Though research has not consistently shown that support groups help alleviate depression in HIV-positive people, it has found, over and over again, that strong social support networks play an important role in lifting people out of depression.
- If your diagnosis has led to social isolation and this is one of the reasons you are now depressed, you may find a new and very positive (no pun intended!) social group in others who face the same challenges you do. Other people living with HIV will understand what you're going through better than anyone else.
- Other HIV+ people aren't going to discriminate against you because you're positive, and can act as a kind of buffer that minimizes the impact discriminatory experiences have on your mental health.
5. Explore alternative ways to alleviate depression
The same "alternative" treatments for depression that can help people who don't have HIV can help you, too, though it's always wise to consult your doctor before trying one if you have reason to believe that it may not be suitable for you.
Lifestyle changes scientific studies have consistently shown to help alleviate the symptoms of depression include:
- Exercising regularly, particularly outdoors.
- "Mindfulness", a practice in which you essentially focus on experiencing the present moment without judgment, and seek to minimize worries about the future.
- Other kinds of meditation.
- Pet therapy. A companion animal can do a lot to reduce your perception of social isolation.
- It is possible that a healthy diet plays a role in alleviating depression, though more studies are needed. Deficiencies in vitamins B12 and B6 can both exacerbate depression, and maybe even trigger it.
- Improved sleep quality leads to an improvement in depression symptoms. Try to practice sleep hygiene to allow you to get to sleep and stay asleep more easily.
HIV+ people have a much higher risk of becoming depressed than others, to the point where screening for depression should be a routine part of medical care. If you are currently feeling depressed, however, that doesn't mean you're doomed to be depressed forever. Accessing treatments, which can include medication and talk therapy as well as lifestyle interventions, can help you overcome depression. This is especially important for you if you are HIV positive, because treating your depression increases your health and the odds that you'll be able to adhere to your medication regime.