Depression and HIV

People often say that they are ‘depressed’ when they are feeling down or sad. Often this is a natural change in mood or an appropriate reaction to an upsetting event or situation. Everyone will experience this at times.

However, depression is an illness, and it is treatable. Mental health professionals often talk about ‘clinical depression’ or ‘major depression’ when they are referring to this condition. It lasts longer and is more severe than experiencing brief times when you feel sad.

If you need help now

This page gives general information about depression. If you have seriously harmed yourself, or you feel that you might, you should do one of the following:

• Call emergency services.
• Go to the emergency department at your local hospital.

Symptoms and signs of depression

Two key signs of depression are:

• feeling down, depressed, or hopeless
• losing pleasure in activities that you used to find meaningful and enjoyable.

You may also have some or all of the following symptoms, for some or all of the time over a period of weeks or even months (rather than for a few hours or days):

• low mood
• feelings of low self-worth
• inappropriate or excessive feelings of guilt
• problems concentrating
• sleeping problems (difficulty in falling or staying asleep, or oversleeping constantly)
• feeling irritable, nervous or agitated
• feeling like your movements and thoughts are slower than normal
• changes in your eating habits (losing your appetite or overeating)
• reduced sex drive
• spending more time than usual away from your family, friends and loved ones
• thinking about death, dying, or harming yourself.

Some of the most common signs of depression are fatigue, tiredness, and low energy. However, this fatigue or tiredness might be associated with a physical health condition, such as low testosterone levels or hypothyroidism. It’s very important that you ask for a physical check-up if you have low energy.

Causes of depression

There are many different causes of depression, including biological, psychological, and social factors. Common causes are upsetting life events such as losing a loved one, divorce, and losing your job. Some people develop depression after having a baby or around the menopause. There might be more than one reason that you develop depression. There might also be no obvious reason.

Whatever the causes may be, depression can become a serious problem for some people. It can even become dangerous if you think about harming yourself or ending your own life. Paying attention to the signs of depression and doing something about it can be life saving.

Depression in people living with HIV

Depression occurs more frequently in people living with HIV than in the general population. It’s not known for sure why this is the case, but there could be several reasons.

• The physical effects of HIV itself can trigger depression.
• Having a long-term health condition of any kind can cause depression or make it worse.
• Some of the groups often affected by HIV – including gay men, ethnic minorities, women and transgender people – already have higher rates of depression than the general population.

Some research suggests that people with HIV and hepatitis C co-infection also have high rates of depression.

Depression and HIV medication

Depression can be a side effect of some anti-HIV medications. Side effects that affect your emotional and mental health, including depression, are more common if you are taking:

• efavirenz (Sustiva, also in Atripla)
• dolutegravir (Tivicay, also in Triumeq, Juluca and Dovato)
• rilpivirine (Edurant, also in Eviplera, Odefsey and Juluca).

Feeling depressed can also affect how you feel about HIV treatment and whether you can take your medication as prescribed (this is sometimes called ‘adherence’). It’s important that you and your doctor talk about how you feel. Your HIV clinic can also help you with adherence if you are finding it hard.

Treatment for depression

It is important to get professional help if you think you are experiencing depression.

Try talking to someone you trust – perhaps a friend, colleague, partner, or family member – about how you feel and where you could get more support. You should not think that you are weak, unstable, or ‘mad’. In fact, it’s a sign of strength that you are reaching out for some help.

If depression is not treated, it will not go away permanently. You may feel better for a while, but it’s likely that you will have another episode of depression in the future. The good news is that psychological treatments for depression work very well and they can reduce the chance of depression coming back.

If you think you need professional help, your GP or HIV doctor will be able to help. HIV doctors are very used to working with people who are experiencing depression.

Seek help immediately if you are thinking of harming or killing yourself. See the section ‘If you need help now’ at the beginning of this page for more information.

Medication for depression

If you have depression, your doctor may recommend that you take antidepressant medication. These medications do not cure depression, but they help you with the symptoms.

Antidepressants should start to make you feel better within four weeks, and you might feel better sooner than this. Your dose may need to be increased for the drug to work properly. Like all medicines, they can have side effects, but not everyone will experience them.

It’s a good idea to let your doctor know you are also taking anti-HIV medication. This way they can avoid any interactions between your medications. If this is difficult, make sure you tell your HIV clinic about any medication your GP has prescribed.

There are four main types (classes) of antidepressant drugs:

• SSRIs (selective serotonin re-uptake inhibitors)
• tricyclics
• SNRIs (serotonin and noradrenaline re-uptake inhibitors, also called serotonin and norepinephrine re-uptake inhibitors)
• MAOIs (monoamine oxidase inhibitors).

If your doctor prescribes an antidepressant, it will probably be an SSRI. These have fewer side effects and interactions with other medications. Sertraline, citalopram, and escitalopram are often used because they have few interactions with anti-HIV medications and generally don’t cause as many side effects.

"There are many different causes of depression, including biological, psychological, and social factors."

The side effects of SSRI antidepressants often happen in the first few weeks of taking them. Side effects at this time can be difficult to cope with because you might still have symptoms of depression. Discuss any concerns about side effects with your doctor.

How long you need to take antidepressants for will depend on your individual circumstances. You may start to feel a lot better a few weeks after you start taking them, but it is highly recommended that you stay on antidepressants for at least six months after you feel better.

It's important not to stop suddenly as this can cause symptoms that can be difficult to cope with (withdrawal symptoms). If you want to reduce your dosage of antidepressants, talk to your doctor about how to do this safely.

St John's wort and depression

Some people choose to take a herbal remedy called St John’s wort for depression. In the UK, doctors cannot prescribe St John’s wort. You must not take St John’s wort if you are taking:

• atazanavir (Reyataz, also in Evotaz)
• bictegravir (Biktarvy)
• cabotegravir (Vocabria)
• doravirine (Pifeltro, also in Delstrigo)
• efavirenz (Sustiva)
• elvitegravir (Genvoya, Stribild)
• etravirine (Intelence)
• fostemsavir (Rukobia)
• lenacapavir (Sunlenca)
• lopinavir (Kaletra)
• maraviroc (Celsentri)
• nevirapine (Viramune)
• rilpivirine (Edurant also in Odefsey, Eviplera, Rekambys, and Juluca)
• medications which contain tenofovir alafenamide (TAF) including Descovy, Genvoya, Odefsey, Symtuza and Biktarvy.

This is because St John’s wort lowers the levels of these anti-HIV medications in your blood and this can lead to the development of drug-resistant HIV.

Talking therapy

Antidepressants can be an important part of recovery from depression. But they are only one of the treatments available. It’s often helpful to combine antidepressants with a ‘talking therapy’. There is evidence that talking therapies can be just as effective, or even more effective in some cases.

A good way to find a counsellor or therapist is to ask at your HIV clinic, another HIV organisation or GP surgery about their services or contacts they may have. You could also find someone through a nationally recognised organisation.

If you live in England, you can also refer yourself for free therapy through the NHS's Improving Access to Psychological Therapies (IAPT) scheme.

Lifestyle changes

Exercise can help with mild depression. It is something you can do yourself, but your GP may also be able to help by prescribing exercise and referring you to a programme at a local gym or health centre.