Depression and HIV

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

Where should I get medication for depression?

It is best to get antidepressants from a psychiatrist although, if this is not possible, your regular physician can prescribe antidepressants. Effective medication depends on correct diagnosis. Diagnosis of psychological symptoms requires specialized training and prescribing psychoactive drugs optimally requires experience. Proper dosage can be critical, and the choice of effective drugs can be subtle. Therefore, a psychiatrist is the best physician to prescribe antidepressants.

It is important to see a psychiatrist who is well trained and up-to-date on the use of psychoactive drugs. Psychiatrists who specialize in the use of medication are called psycho-pharmacologists. Psycho-pharmacologists are more likely to choose the most suitable drug for you and are more likely to prescribe appropriate doses. They are trained to have an organized strategy for trying different drugs if the first is not successful.

A psychiatrist or psycho-pharmacologist who has experience in treating patients with HIV disease will give you the best advice. This is less important if you are physically asymptomatic and more important if you have major medical symptoms. If you see a psychiatrist for a medication consultation, you should be able to give him or her a clear picture of your current and past illnesses and medications. It is useful to have the psychiatrist talk to your physician, especially if the psychiatrist does not have extensive experience in treating people with HIV disease. If you live in a large metropolitan area, you should be able to locate a psychiatrist who is experienced in treating people with HIV infection.

If your physician cannot give you a referral to a psychiatrist, you can request a list of possible referrals from the psychiatry department of the major medical center in your area, particularly if it affiliated with a medical school. AIDS organizations may be able to refer you to psychiatrists as well.

If you are unable for any reason, financial or otherwise, to see a psychiatrist, you may get antidepressants from your regular physician. Often this is a successful approach since many people respond well to the first drug they are given for depression and have few complications. This has become less problematic since the SSRIs are usually less complicated to prescribe than older antidepressants. However, your regular doctor may lack the expertise and the time to make a careful assessment. Physicians (and even some psychiatrists) inexperienced with medication sometimes prescribe antidepressant or anti-anxiety drugs at doses that are not ideal. Non-specialists may also give up if the first medication does not work. If you are treated for depression by your regular physician and do not respond, you should make every effort to see a psychiatrist rather than give up.

If you are in therapy with a well-trained psychologist or social worker, s/he will be able to make a preliminary diagnosis of depression and refer you to a psychiatrist. At that point the therapist and psychiatrist will consult and work with you collaboratively. If you are not already in therapy, the psychiatrist should refer you to a non-medical therapist for talk therapy. Some psychiatrists provide both medication and talk therapy.

Consultation for medication with a psychiatrist for medication generally involves several closely spaced visits (usually weekly) with a psychiatrist while you start medication, and then occasional more widely spaced visits to monitor your progress on the drug. Your contact with the psychiatrist will not be as frequent or regular as visits for psychotherapy.