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Canadian Journal of Infectious Diseases
Volume 12 (2001), Suppl C, Pages 9C-19C
http://dx.doi.org/10.1155/2001/821810

Management of Depression and Related Neuropsychiatric Symptoms Associated with HIV/AIDS and Antiretroviral Therapy

Mark Halman

HIV Psychiatry Program and the Medical Psychiatry Consultation Service , and Inner City Health Program, St Michael’s Hospital, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Copyright © 2001 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Persons with HIV/AIDS may experience a wide range of neuropsychiatric symptoms, including depressed mood, anxiety, irritability, suicidal ideation, agitation and insomnia. These symptoms may be related to psychosocial stressors, biological diathesis to psychiatric syndromes, HIV-related medical illness and/or the medications used in the treatment of HIV/AIDS. Depressed mood is the most common neuropsychiatric complaint in persons with HIV/AIDS seeking psychiatric evaluation. Prevalence rates of major depression in persons with HIV/AIDS have been reported to range between 22% and 45%. Despite the high prevalence, major depression remains underdiagnosed in patients with HIV/AIDS. Depression has a significant impact on quality of life, has a negative impact on antiretroviral adherence and is a significant risk factor for suicide. With the advent of highly active antiretroviral therapy, HIV/AIDS has evolved into a chronic, manageable illness. The management of mental health concerns and neuropsychiatric symptoms has, therefore, become an integral part of comprehensive HIV/AIDS care. Clinical experience to date suggests that psychiatric syndromes in persons with HIV/AIDS and treatment-emergent neuropsychiatric side effects related to antiretroviral medications can be successfully managed using standard psychiatric interventions. The present article focuses on the treatment and management of major depression, including the choice of antidepressants and potential drug interaction considerations. Management of related symptoms of agitation and sleep disturbances are also reviewed.