Depression

Following a HIV diagnosis most individuals experience symptoms which include sleep difficulties, increased fatigue, inability to focus, unable to experience pleasure, agitation, being hopeless, suicidal thoughts, feeling guilty. These symptoms describe depression. Depression is an expected reaction to a diagnosis of a fatal disease. The rates of depression observed during the first decade of the epidemic when the median age for an AIDS diagnosis was 36 (1989, CDC) were 3-5 times higher than in the general population. In 1995 ART was introduced, turning a rapid and almost inevitable death sentence into the promise of a long-life span. Yet, 30 years later in older adults including Long Term Survivors the rates of depression remain 3-5 times higher than seen in a typical age matched population without HIV.

 

Depression in people living with HIV responds to the multiple treatment strategies available. This includes treatment with anti-depressants, verbal therapies such as groups, one on one counseling, as well as CBT (Cognitive Behavioral Therapy). Severe depression can warrant hospitalization in order to identify and achieve optimal management choices. Depression management can include life-style changes such as reducing sources of stress, increased exercise and social engagement.

What you can do with your doctor

 

Your primary care physician screens you for multiple disorders by taking blood and urine samples, health histories and other diagnostics. Depression is a well-established comorbidity of HIV in older adults. You must ask your primary care physician to ALSO screen you for depression regardless of whether you or your doctor believes you are depressed. In addition to physical tests and examinations, your doctor and/or clinician should also be conducting an annual mental illness assessment. There are multiple rapid screening tools for depression ( http://hiv-age.org/2016/01/26/depression-in-the-aging-hiv-infected-population/). These include the 9 question PHQ-9 or the 20 question CES-D. Any mental illness is best managed by a trained professional in cooperation with your primary care physician.

Most often management of a mental illness is a continual process requiring adjustments in treatments. A diagnosis of depression does not mean you will be depressed for the rest of your life, or that you will need to take medications or be in therapy forever. If you are being treated for depression and continue to be depressed – tell your doctor. If your depression is being well managed – ask your doctor if you might be able to stop any medications or treatments. The bottom line is that you must advocate for mental illness care. Depression places you at high risk for multimorbidity and increased severity of those illnesses associated with aging.

What you can do

First, insist on being screened for depression. You must be your own advocate. Follow all depression management plans including adherence to medications. Depression can be exacerbated by certain high stress situations: these might include your work or volunteer environment; or interaction with a certain friend or family members. One of the manifestations of depression is the withdrawal that occurs. This is in part evidenced by the social isolation that occurs. You must actively break the cycle of social isolation. Social isolation causes depression to become worse. Engagement is important. Check your local AIDS Service Organizations and LGBT Center   for activities that will allow you to socialize. Organizations like the AARP is another resource as are religious congregations. Another option is to volunteer. Finding someone to partner with you to engage these new lifestyle changes makes the process easier.

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