YOU ARE HERE:
Mental health
Mental health problems can affect anybody, but it seems that people with HIV are more likely to experience a range of mental health problems, not least because the groups most affected by HIV in the UK, gay men, refugees and migrants and drug users, are already more likely to have mental health problems. Advanced HIV infection itself is known to increase the risk of developing some infections which involve mental health problems, although these are now very rare. More common are feelings of acute emotional distress which often accompany adverse life-events and clinical mental disorders such as depression and anxiety. In addition some anti-HIV drugs can cause psychological disturbance.
HIV related mental disorders
It is estimated that before anti-HIV treatments became widely used 7% of people with advanced HIV infection would develop dementia. (see NAM Factsheet 10, Dementia, which was last updated in June 2002). Mania has also been observed in people with advanced HIV disease. It is highly unusual for a person who has been treated with anti-HIV drugs to develop either of these conditions as a direct result of being HIV-positive.
Emotional distress
Particular events such as receiving an HIV diagnosis, bereavement, the break down of a relationship, financial or work problems, or dealing with side-effects of treatment can result in feelings of deep unhappiness which are difficult to manage and interfere in the ability to get on with day-to-day life.
Support from family and friends can be very helpful at these times, as can professional help, such as HIV and other helplines, and counselling. Many HIV clinics have specialist mental health teams and some HIV support agencies can offer short courses of counselling. Some people also find that complementary therapies, such as acupuncture can relieve some of the symptoms of emotional distress, although these are now rarely provided by HIV clinics.
Depression
Depression is a clinical illness and is twice as common in people with HIV as in the general population.
Depression can be triggered by illness or social problems, however it is not uncommon for there to be no readily identifiable cause. It is characterised by the presence of most or all of the following symptoms on a daily basis for several weeks: low mood; apathy; poor concentration; irritability; insomnia; early waking or oversleeping; inability to relax; weight gain or weight loss; loss of pleasure in usual activities; feelings of low self-wroth; excessive guilt; and recurrent thoughts of death or suicide.
If you are diagnosed with depression, your doctor may recommend that you take antidepressant drugs, which relieve the symptoms of depression by altering chemicals in the brain which influence mooed and behaviour. They can take several weeks to work and may have side effects.
Although there are three classes of antidepressant drugs used (tricyclics; MAOIs; and SSRIs), it is most likely that you will be offered a drug from the SSRI (selective serotonin re-uptake inhibitors) class, which includes drugs like fluoxetine (Prozac), as these have fewest side-effects and interactions with other drugs. It is not uncommon for drugs in this class to cause sexual problems. You must not take the herbal antidepressant St John’s wort if you are taking a protease inhibitor or an NNRTI.
The amount of time you stay on antidepressants will vary on your individual circumstances and although you may start to feel better soon after starting to take them, it is recommended that you remain on them for at least three months if it is your first depressive illness or longer if you have your depression has recurred.
Mental health problems as a treatment side-effect
It is known that the anti-HIV drug efavirenz (Sustiva) can cause psychological disturbances. Some people have difficulty sleeping, or vivid dreams or nightmares. Other people have reported depression without any other apparent cause.
Anxiety
Anxiety is a feeling of panic or apprehension, which is often accompanied by physical symptoms such as sweating, rapid heart beat, agitation, nervousness, headaches and panic attacks. Anxiety can accompany depression or be seen as a disorder by itself, often caused by circumstances which result in fear, uncertainty or insecurity.
If anxiety is caused by practical problems then getting advice, talking the problem through or counselling might be helpful. Anxiety which accompanies depression is relieved by antidepressant drugs. Some people find massage or other complementary therapies help relieve the symptoms of anxiety.
Drugs such as benzodiazepines, including Valium, are now very rarely prescribed as a treatment for long-term anxiety as they are addictive. However, they are still used in the treatment of short periods of acute anxiety without any long-term dependency problems.
Psychological treatments
Often drug therapies for mental problems work better if accompanied by psychological interventions designed to help people understand and control their feelings. Examples include psychotherapy, and cognitive behavioural therapy (CBT), both of which usually involve a short course of sessions with a psychotherapist or psychologist.