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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 17 (2006), Suppl D, Pages 5D-9D
http://dx.doi.org/10.1155/2006/254238

Management of Depression Associated with HIV/AIDS and Antiretrovial Therapy

Mark Halman

HIV Psychiatry Program and Centre for Research in Inner City Health, St Michael’s Hospital, and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Copyright © 2006 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

Depressed mood is a common psychiatric complaint in persons with HIV/AIDS, with a meta-analysis indicating that the rates of depression within this group may be as high as double that of the general population. Depression may result from a biological diathesis to mood disorders, a physiological reaction to a medical illness or its treatment, and/or a psychological reaction to challenging life circumstances. Associated symptoms include sleep, energy and appetite disturbances; social withdrawal; diminished capacity to experience pleasure; diminished concentration; feelings of worthlessness, shame and guilt; and recurrent thoughts of death, including suicidal ideation. The emotionally and physically painful state of major depression is associated with decreased antiretroviral adherence and poorer HIV/AIDS disease outcomes. Neuropsychiatric symptoms have been reported with several of the medications taken by patients with HIV/AIDS, including lamivudine, zidovudine, interferon and, most notably, efavirenz. However, data from several sources demonstrate that neuropsychiatric symptoms associated with efavirenz use are generally transient, with onset early after treatment initiation, peaking after one week and decreasing over the first one to four months of treatment. Recent comparative studies have not found elevated incident rates of major depression in patients treated with efavirenz, but they have confirmed the typical neuropsychiatric symptoms reported in earlier open-label studies and case reports. Becoming skilled in the management of depression and psychiatric symptoms is integral to the provision of comprehensive care for patients with HIV/AIDS.