What Are the Signs of Depression?

What Are the Signs of Depression?

Symptoms of depression vary from person to person. Most health care providers suspect depression if patients report feeling blue or having very little interest in daily activities. If these feelings go on for two weeks or longer, and the patient also has some of the following symptoms, they are probably depressed:

• Fatigue or feeling slow and sluggish
• Problems concentrating
• Low sex drive
• Problems sleeping; waking very early or excessive sleeping
• Feeling guilty, worthless, or hopeless
• Decreased appetite or weight loss
• Overeating

What Causes Depression?

Some medications used to treat HIV can cause or worsen depression, especially efavirenz (Sustiva). Diseases such as anemia or diabetes can cause symptoms that look like depression. So can drug use, or low levels of testosterone, vitamin B6 or vitamin B12.

People who are infected with both HIV and hepatitis B or C (see Fact Sheet 506) are more likely to be depressed, especially if they are being treated with interferon.

Other risk factors include:

• Being female
• Having a personal or family history of mental illness, alcohol and substance abuse
• Not having enough social support
• Not telling others you are HIV-positive
• Treatment failure (HIV or other)

Treatment for Depression

Depression can be treated with lifestyle changes, alternative therapies, and/or with medications. Many medications and therapies for depression can interfere with your HIV treatment. Your health care provider can help you select the therapy or combination of therapies most appropriate for you. Do not try to self-medicate with alcohol or illegal drugs as these can increase depression and create additional problems.

Lifestyle changes can improve depression for some people. These include:

• Regular exercise
• Increased exposure to sunlight
• Stress management
• Counseling
• Improved sleep habits

Alternative Therapies

Some people get good results from massage, acupuncture, or exercise. St. John's Wort is widely used to treat depression. However, it interferes with some HIV medications. Fact Sheet 729 has more about St. John's Wort. Be sure to tell your health care provider if you are taking St. John's Wort.

Valerian or Melatonin may help improve your sleep. Supplements of vitamins B6 or B12 can help if you have a shortage.

Antidepressants

Some people with depression respond best to medication. Antidepressants can interact with ARVs. They must be used under the supervision of a health care provider who is familiar with your HIV treatment. Protease inhibitors have many interactions with antidepressants.

The most common anti-depressants used are Selective Serotonin Reuptake Inhibitors, called SSRIs. They can cause loss of sexual desire and function, lack of appetite, headache, insomnia, fatigue, upset stomach, diarrhea, and restlessness or anxiety.

The tricyclics have more side effects than the SSRIs. They can also cause sedation, constipation, and erratic heart beat.

Some health care providers also use psychostimulants, the drugs used to treat attention deficit disorder.

A recent study showed that treatment with dehydroepiandrosterone (DHEA) can reduce depression in some HIV patients.