Depression and HIV

October 2003     View PDF     En español
Reprinted from www.aidsmeds.com, US

What are the possible treatments for depression?

Psychotherapy is helpful in treating depression. If you are depressed, it is crucial that you have someone to listen to your feelings, provide support and help you understand what is troubling you. Although friends, lovers, and family may serve some of these functions, it is best to have a well-trained, more objective mental health professional provide you with help. Supportive talk therapy need not be lengthy.

Medication with antidepressants is the quickest way to relieve major depression and is definitely indicated for severe depression that is associated with suicidal thoughts and/or major disruption of functioning. Appropriate medication can relieve symptoms and allows you to go on with your life. In general, two thirds of patients with a major depressive disorder will respond positively to the use of medication within two weeks to two months. Most of the rest will get better when they try another antidepressant. Major depression is one of the most treatable of medical conditions.

Medication also works for dysthymia. Although the improvement may look less dramatic than in major depression, it can lead to a meaningful improvement in your life.

The best treatment for both major depression and dysthymia is a combination of medication and talk therapy. Numerous studies show that both psychotherapy and medication are very effective in treating depression. A recent study (and a great deal of clinical experience) indicates that probably a combination of the two is most effective in treating depression.

Aren’t antidepressants just “happy pills” that will cover up the real problem and keep me from solving it?
No. If you are not depressed and take antidepressants, they will not improve your mood or functioning. People who are significantly depressed often lack the perspective and energy to understand and deal with underlying problems. Many therapists report that patients who are treated with antidepressants make more progress in talk therapy because they have the ability to grapple with emotional and practical problems when the depression is lessened with medication.

Aren’t psychiatric drugs only for people with severe mental illness?
It is a common fear that taking medication means you are “crazy,” or that medication will sedate you into being a zombie, change your identity as a person, or disarm appropriate anger at social injustice. These fears are unrealistic. Psychoactive drugs are useful for people with a wide range of problems, not just people who are “crazy.” People who are generally well functioning psychologically can have on-and-off periods of depression, particularly when confronting the stress of HIV disease. There is no reason why you should suffer such distress when safe, effective medication can reduce the burden you have been forced to carry.

When a major source of stress is present, such as HIV-related problems, you may tend to accept depression as inevitable, understandable, and unchangeable and, therefore, inappropriate for medication-oriented treatment. However, just because a source of stress is known, doesn’t mean medical treatment should be ruled out. We understand an arm can be fractured because of the stress of a fall; but we still set the bone in a cast.

While some drugs used to treat severely disturbed people are sedating, the drugs normally prescribed for milder problems are not. Drugs used to treat depression generally restore you to normal mood rather than blunting or blurring all feelings or robbing you of emotion or passion. A small number of people do experience a sense of apathy or flatness on some antidepressants. In this case, a different antidepressant could be tried that may not have the same effect.

Like other drugs, psychoactive medications have some side effects. Many of these side effects are typically noticeable when you start treatment, and diminish or disappear after a few weeks, though some may be more persistent. When prescribed correctly, psychoactive drugs do not dull your intelligence or your ability to perceive reality.

Depression inhibits your ability to see the world clearly and act effectively. By reducing anxiety and depression, drugs help some people clarify their thinking and become more active.