It’s generally thought that about five per cent of HIV positive people will develop a major depressive illness. A major depression is diagnosed if you have a number of symptoms lasting for several weeks or months. These include a general feeling of sadness, lack of concentration, poor sleeping patterns, hopelessness, and thoughts about death or suicide.
HIV positive gay men are about twice as likely as HIV negative gay men to develop depression. Less is known about how common depression is in HIV positive Africans, possibly because Africans are less likely to bring depression to their doctors’ attention.
It seems, however, that mild mental health problems are experienced by a far larger number of people with HIV. A recent study conducted in America revealed that almost three-quarters of people with HIV said they felt depressed some of the time, two-thirds said that they had felt anxious, and a half reported trouble sleeping.
Are mental health problems becoming more or less common?
That’s a difficult one. There is some evidence to suggest that in countries like the UK and US the general optimism of people with HIV has improved with the advent of effective anti-HIV treatments. One recent US study found that after 1996, the mental health of people on treatment, starting treatment, and not on treatment improved significantly.
On the other hand, the side effects that can be caused by anti-HIV drugs and problems with money, housing, employment and relationships can all contribute to mental health problems.
Can anti-HIV drugs cause mental health problems?
Yes, the NNRTI efavirenz, in particular, has been associated with sleep disturbances, feeling confused, depression, thoughts of suicide and self-harm, and in rare instances psychosis. Not everybody who takes efavirenz experiences these side effects and in most cases they are mild and become more tolerable or disappear over time.
If you have a past history of depression, anxiety or any other mental health problem then you should make sure that your doctor knows before you start taking efavirenz. This may mean that you are more likely to experience mental health problems if you take the drug.
There have been rare case reports of some other anti-HIV drugs causing mental health problems, with drugs in the NRTI and PI classes possibly linked with psychosis.
Anti-HIV drugs can also indirectly cause mental health problems by causing side effects. Lipodystrophy can cause a loss of self-confidence and self-esteem, and a US study found that many people taking anti-HIV drugs would be willing to see their life-expectancy shorten by two years rather than develop the side effect.
What about treatments for other illnesses?
Pegylated interferon or interferon-alfa, used to treat hepatitis C virus, can cause very severe depression. If you have hepatitis C and need to take this drug you may well be recommended to take antidepressants.
Can you take antidepressants if you are taking anti-HIV drugs?
Yes, antidepressants can be taken if you are on anti-HIV medication, and drugs from the SSRI (selective serotonin re-uptake inhibitors) class, which includes drugs like fluoxetine (Prozac) are least likely to cause problems if you are taking anti-HIV drugs. But make sure that your HIV doctor and pharmacist knows that you are taking them!
A word of warning, the herbal antidepressant St John’s wort can reduce blood levels of NNRTIs and protease inhibitors.
You don’t hear much about dementia in Aids patients any more. Has it gone away?
Anti-HIV drugs have helped improve the life expectancy of people who do get dementia, to the degree that there are more people around who are living with some degree of HIV-related dementia.
However the same treatments mean that people with HIV are much less likely to get such severe immune suppression that they are at risk of dementia. Even before good anti-HIV treatments became available doctors had become quite skilled at using other drugs to prevent dementia in people with even very severe immune suppression.
Questions and Answers with NAM Michael Carter, Editor, Patient Information
