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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


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