Provided by the National Institute of Mental Health
Symptoms of Depression
Persistent sad, anxious, or "empty" mood
Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities that were once enjoyed,
including sex
Decreased energy, fatigue, being "slowed down"
Difficulty concentrating, remembering, making decisions
Insomnia, early-morning awakening, or oversleeping
Appetite and/or weight changes
Thoughts of death or suicide, or suicide attempts
Restlessness, irritability
If five or more of these symptoms are present every day for at least two weeks
and interfere with routine daily activities such as work, self-care, and
childcare or social life, seek an evaluation for depression.
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Introduction
Research has enabled many men and women, and young people living with human
immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency
syndrome (AIDS), to lead fuller, more productive lives. As with other serious
illnesses such as cancer, heart disease or stroke, however, HIV often can be
accompanied by depression, an illness that can affect mind, mood, body, and
behavior. Treatment for depression helps people manage both diseases, thus
enhancing survival and quality of life.
Despite the enormous advances in brain research in the past 20 years, depression
often goes undiagnosed and untreated. Although as many as one in three persons
with HIV may suffer from depression,1 the warning signs of depression are often
misinterpreted. People with HIV, their families and friends, and even their
physicians may assume that depressive symptoms are an inevitable reaction to
being diagnosed with HIV. But depression is a separate illness that can and
should be treated, even when a person is undergoing treatment for HIV or AIDS.
Some of the symptoms of depression could be related to HIV, specific HIV-related
disorders, or medication side effects. However, a skilled health professional
will recognize the symptoms of depression and inquire about their duration and
severity, diagnose the disorder, and suggest appropriate treatment.
Depression Facts
Depression is a serious medical condition that affects thoughts, feelings, and
the ability to function in everyday life. Depression can occur at any age. NIMH-sponsored
studies estimate that 6 percent of 9- to 17-year-olds in the U.S. and almost 10
percent of American adults, or about 19 million people age 18 and older,
experience some form of depression every year.2,3 Although available therapies
alleviate symptoms in over 80 percent of those treated, less than half of people
with depression get the help they need.3,4
Depression results from abnormal functioning of the brain. The causes of
depression are currently a matter of intense research. An interaction between
genetic predisposition and life history appear to determine a person's level of
risk. Episodes of depression may then be triggered by stress, difficult life
events, side effects of medications, or the effects of HIV on the brain.
Whatever its origins, depression can limit the energy needed to keep focused on
staying healthy, and research shows that it may accelerate HIV's progression to
AIDS.5,6
HIV/AIDS Facts
AIDS was first reported in the United States in 1981 and has since become a
major worldwide epidemic. AIDS is caused by the human immunodeficiency virus
(HIV). By killing or damaging cells of the body's immune system, HIV
progressively destroys the body's ability to fight infections and certain
cancers (http://www.nci.nih.gov/).
The term AIDS applies to the most advanced stages of HIV infection. More than
700,000 cases of AIDS have been reported in the United States since 1981, and as
many as 900,000 Americans may be infected with HIV.7,8 The epidemic is growing
most rapidly among women and minority populations.9
HIV is spread most commonly by having sex with an infected partner. HIV also is
spread through contact with infected blood, which frequently occurs among
injection drug users who share needles or syringes contaminated with blood from
someone infected with the virus. Women with HIV can transmit the virus to their
babies during pregnancy, birth, or breast-feeding. However, if the mother takes
the drug AZT during pregnancy, she can reduce significantly the chances that her
baby will be infected with HIV.
Many people do not develop any symptoms when they first become infected with
HIV. Some people, however, have a flu-like illness within a month or two after
exposure to the virus. More persistent or severe symptoms may not surface for a
decade or more after HIV first enters the body in adults, or within two years in
children born with HIV infection. This period of "asymptomatic" (without
symptoms) infection is highly individual. During the asymptomatic period,
however, the virus is actively multiplying, infecting, and killing cells of the
immune system, and people are highly infectious.
As the immune system deteriorates, a variety of complications start to take
over. For many people, their first sign of infection is large lymph nodes or
"swollen glands" that may be enlarged for more than three months. Other symptoms
often experienced months to years before the onset of AIDS include:
Lack of energy
Weight loss
Frequent fevers and sweats
Persistent or frequent yeast infections (oral or vaginal)
Persistent skin rashes or flaky skin
Pelvic inflammatory disease in women that does not respond to treatment
Short-term memory loss
Many people are so debilitated by the symptoms of AIDS that they cannot hold
steady employment or do household chores. Other people with AIDS may experience
phases of intense life-threatening illness followed by phases in which they
function normally.
Because early HIV infection often causes no symptoms, a doctor or other health
care worker usually can diagnose it by testing a person's blood for the presence
of antibodies (disease-fighting proteins) to HIV. HIV antibodies generally do
not reach levels in the blood which the doctor can see until one to three months
following infection, and it may take the antibodies as long as six months to be
produced in quantities large enough to show up in standard blood tests.
Therefore, people exposed to the virus should get an HIV test within this time
period.
Over the past 10 years, researchers have developed antiretroviral drugs to fight
both HIV infection and its associated infections and cancers. Currently
available drugs do not cure people of HIV infection or AIDS, however, and they
all have side effects that can be severe. Because no vaccine for HIV is
available, the only way to prevent infection by the virus is to avoid behaviors
that put a person at risk of infection, such as sharing needles and having
unprotected sex.
Get Treatment for Depression
While there are many different treatments for depression, they must be carefully
chosen by a trained professional based on the circumstances of the person and
family. Prescription antidepressant medications are generally well-tolerated and
safe for people with HIV. There are, however, possible interactions among some
of the medications and side effects that require careful monitoring. Specific
types of psychotherapy, or "talk" therapy, also can relieve depression.
Some individuals with HIV attempt to treat their depression with herbal
remedies. However, use of herbal supplements of any kind should be discussed
with a physician before they are tried. Scientists recently discovered that St.
John's wort, an herbal remedy sold over-the-counter and promoted as a treatment
for mild depression, can have harmful interactions with other medications,
including those prescribed for HIV. In particular, St. John's wort reduces blood
levels of the protease inhibitor indinavir (Crixivan®) and probably the other
protease inhibitor drugs as well. If taken together, the combination could allow
the AIDS virus to rebound, perhaps in a drug-resistant form.
Treatment for depression in the context of HIV or AIDS should be managed by a
mental health professional—for example, a psychiatrist, psychologist, or
clinical social worker—who is in close communication with the physician
providing the HIV/AIDS treatment. This is especially important when
antidepressant medication is prescribed, so that potentially harmful drug
interactions can be avoided. In some cases, a mental health professional that
specializes in treating individuals with depression and co-occurring physical
illnesses such as HIV/AIDS may be available. People with HIV/AIDS who develop
depression, as well as people in treatment for depression who subsequently
contract HIV, should make sure to tell any physician they visit about the full
range of medications they are taking.
Recovery from depression takes time. Medications for depression can take several
weeks to work and may need to be combined with ongoing psychotherapy. Not
everyone responds to treatment in the same way. Prescriptions and dosing may
need to be adjusted. No matter how advanced the HIV, however, the person does
not have to suffer from depression. Treatment can be effective.
It takes more than access to good medical care for persons living with HIV to
stay healthy. A positive outlook, determination, and discipline are also
required to deal with the stresses of avoiding high-risk behaviors, keeping up
with the latest scientific advances, adhering to complicated medication
regimens, reshuffling schedules for doctor visits, and grieving over the death
of loved ones.
Other mental disorders, such as bipolar disorder (manic-depressive illness) and
anxiety disorders, may occur in people with HIV or AIDS, and they too can be
effectively treated. For more information about these and other mental
illnesses, contact NIMH.
Remember, depression is a treatable disorder of the brain. Depression can be
treated in addition to whatever other illnesses a person might have, including
HIV. If you think you may be depressed or know someone who is, don't lose hope.
Seek help for depression.
For more information about depression
Please visit the following link for more information about organizations that
focus on depression.
For more information about HIV/AIDS
Please visit the following link for more information about organizations that
focus on HIV/AIDS.
References
1Bing EG, Burnam MA, Longshore D, et al. The estimated prevalence of psychiatric
disorders, drug use and drug dependence among people with HIV disease in the
United States: results from the HIV Cost and Services Utilization Study.
Archives of General Psychiatry, in press.
2Shaffer D, Fisher P, Dulcan MK, et al. The NIMH Diagnostic Interview Schedule
for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence
rates, and performance in the MECA Study. Methods for the Epidemiology of Child
and Adolescent Mental Disorders Study. Journal of the American Academy of Child
and Adolescent Psychiatry, 1996; 35(7): 865-77.
3Regier DA, Narrow WE, Rae DS, et al. The de facto mental and addictive
disorders service system. Epidemiologic Catchment Area prospective 1-year
prevalence rates of disorders and services. Archives of General Psychiatry,
1993; 50(2): 85-94.
4National Advisory Mental Health Council. Health care reform for Americans with
severe mental illnesses. American Journal of Psychiatry, 1993; 150(10): 1447-65.
5Leserman J, Petitto JM, Perkins DO, et al. Severe stress, depressive symptoms,
and changes in lymphocyte subsets in human immunodeficiency virus-infected men.
Archives of General Psychiatry, 1997; 54(3): 279-85.
6Page-Shafer K, Delorenze GN, Satariano W, et al. Comorbidity and survival in
HIV-infected men in the San Francisco Men's Health Survey. Annals of
Epidemiology, 1996; 6(5): 420-30.
7Centers for Disease Control and Prevention (CDC). HIV/AIDS Surveillance Report,
2000; 12(1): 1-44.
8Guidelines for national human immunodeficiency virus case surveillance,
including monitoring for human immunodeficiency virus infection and acquired
immunodeficiency syndrome. MMWR, 1999; 48(RR-13): 1-27, 29-31.
9Centers for Disease Control and Prevention (CDC). HIV Prevention Strategic Plan
Through 2005. Draft, September 2000.
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All material in this brochure is in the public domain and may be reproduced or
copied without permission from the Institute. Citation of the National Institute
of Mental Health as the source is appreciated.
NIH Publication No. 02-5005
Department of Health and Human Services
Public Health Service
National Institutes of Health
National Institute of Mental Health
May 2002
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