You are here

Weathering the blues

People living with HIV are more likely to suffer depression but, as Neil McKellar-Stewart reports, symptoms can be reduced through a range of interventions.

An HIV diagnosis is a profoundly traumatic experience, the psychosocial effects of which burst out like an atomic blast across the personal landscape of most people living with HIV. If the diagnosis is close to the time when the person acquired HIV, the trauma may be compounded by severe physical illness associated with seroconversion. For many people, the experience will trigger a period of significant depression. Similarly, people who have lived with HIV for many years may also suffer depression.

Of course, all of us experience times in our life when we may be feeling flat or down. This is quite normal and is commonly related to periods of change, stress or uncertainty. Most people, however, come out the other side and return to a level mood state. Depression is different altogether.

Major depression feels like being stuck in a deep, dark hole with no means of escape, substantially impairing a person’s ability to function or cope with day-to-day living. It is way beyond sadness. When we are sad we can be distracted from our mood by simple pleasures in life. With depression, we experience a persistent and all-pervading loss of pleasure in anything.

The unpleasant reality is that depression occurs much more frequently in people living with HIV than in the general population. In fact, clinical depression is the most commonly observed mental health disorder among those diagnosed with HIV. Studies have found that the percentage of people with HIV diagnosed with clinical depression ranges between 15 percent and 40 percent — this is around two-to-three times higher than matched individuals living without HIV.

In 2014, La Trobe University researchers undertook an online survey which measured depression, anxiety and stress in gay and bisexual men living with HIV in Australia. It found 21.5 percent had severe or extremely severe depression. The depression scores for these men with HIV were 1.7 times higher than found among their negative peers.

The La Trobe researchers identified a key factor associated with the high depression scores: internalised stigma. This caused people to hide their HIV status from others and made them feel dirty, guilty and ashamed. Results from an online survey of men who have sex with men in the UK and Ireland showed a similar trend. More than half of the men (58 percent) reported symptoms of depression, with internalised stigma the most frequent cause.

As a result of such findings, some jurisdictions have adopted guidelines for the regular monitoring of people with HIV for symptoms of depression. In Australia, for example, the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine recommends that: “People living with HIV should be screened for symptoms of depression, anxiety, drug and alcohol issues, trauma, adjustment difficulties and risk of self-harm within the first three months of receiving an HIV diagnosis, and thereafter annually.”

It’s not just stigma and feelings of low self-esteem that can lead to depression among people living with HIV. Many antiretroviral medications to treat HIV can cause emotional or mental problems as side effects. These side effects may diminish or disappear after a period of days, weeks or months but can also remain long-term. In some cases, changing drugs may be the only option.

Treating depression in people with HIV is critical. If left untreated, depression can cause HIV-positive individuals to stop taking their medication, to stop attending medical appointments, and to actively disengage from healthcare in general. This puts the individual at risk of developing a detectable viral load. Having depression promptly diagnosed and treated is vital in order to reduce the risk of other health issues which are associated with untreated depression, such as acute heart disease, stroke and diabetes.

Recent evidence also suggests untreated depression over many years may lead to high levels of inflammation in the brain which, in turn, contribute to permanent neurodegeneration. So, if you are living with HIV and depression, seeking support to reduce the symptoms is a high priority. Talk with your HIV clinician and, if you’re concerned, request that a screening test be conducted.

If depression is diagnosed, the good news is there are plenty of treatment options available to help you cope with the condition. Lifestyle changes found to be effective in treating depression include psychotherapy, cognitive behaviour therapy, stress management, improved sleeping habits, regular exercise and exposure to sunlight. Massage and acupuncture have also been found as good alternative therapies to treat depression, as have meditation, mindfulness and yoga. Antidepressant medications can also be used to treat depression. (If you are on antidepressants and are also living with HIV, close attention must be paid to any interactive side effects.)

So, while all may seem hopeless, it’s important to remember that depression can be successfully treated and symptoms significantly reduced through a variety of interventions. The first step is to seek medical support so as to receive the right treatment for you.

If you’re suffering from depression you can seek support at Beyond Blue and Lifeline Australia


latest news

June 22, 2018
Two years since its launch, MyLife+ is now recognised as the go-to app for people with HIV in Australia.
May 9, 2018
The federal government's budget details were released last night. Here's a community response.
March 29, 2018
We’re not talking about recovery parties here, but the post-recovery recovery when the festivities have ended.
March 21, 2018
The world has lost one of the most respected scientists in the field of HIV/AIDS, Professor David Cooper.
March 21, 2018
The cost of PrEP (pre-exposure prophylaxis) is to be drastically reduced from 1 April
February 12, 2018
The annual awareness day on 9 March is aimed at encouraging women to test for HIV.
January 22, 2018
Once again, 9 March commemorates the National Day of Women Living with HIV Australia. 
November 30, 2017
On a trip to Bali, David Menadue discovered that it pays to be clued up about travel insurance.
November 30, 2017
Armistead Maupin talks to Steven Petrow about 1970s San Francisco, AIDS and ageing.
November 30, 2017
This year marks the 30th anniversary of the AIDS Memorial Quilt. Read the story behind the icon.
November 29, 2017
They are the all-too forgotten minority: heterosexual men with HIV. Here are their stories.
November 29, 2017
In 2018, researchers will explore a number of approaches that might bring an end to the need for treatment.
November 29, 2017
As people with HIV get older and live longer, they become vulnerable to cardiovascular disease. 
August 22, 2017
A decision to subsidise PrEP has been deferred, much to the disappointment and frustration of HIV advocates.
July 26, 2017
Results from an Australian study show that HIV-positive men on treatment cannot transmit the virus.