Meds, Mind, Body & Benefits > Mental Health & HIV

Depression and HIV

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monarcmarc:
Hi Guys,

One thing that I've noticed when researching some various combos is that often depression will be listed as a side effect.

Which got me thinking, having read some experiences where people have had some unfortunately dark periods, do you think that the depression and anxiety as much as it has been clinically observed in terms of a response to treatment, has just as much to do with the diagnosis and the condition as it does the medication?

I found when I was diagnosed, and even now sometimes, there is definite sense of melancholy that, (for me) I think has a lot to do with the adjustment that is a natural part of the process of dealing with a change in life circumstances. Like the stages of grieving for example, is believed to end in depression and I think in some sense I have grieved the changes. Because I'm a bit melodramatic like that.

I don't want to diminish anybodies experiences where they have had some severe depression or stress or anxiety, but I am curious as to what others think. Do you think it is as much a part of living the HIV+ experience, as it is a side effect of medications, not withstanding the fact that depression has been clinically linked to medication for some people?

Mark

jkinatl2:
That is a really good question. And it's one of the reasons I have been a little more evangelical when it comes to, say, the CNS issues that often accompany Sustiva/Atripla.

For some people, acquiring HIV is a by-product/symptom of major depressive (and other depressive/mood/anxiety) disorder/s. And yet this is not often addressed by the medical community. And it goes without saying that if a geographic relocation is considered one of life's more stressful moments, being diagnosed with a stigma-riddled STD is surely closer tot he top of the list. If someone's decision-making capacity was compromised before diagnosis, I imagine that the fallot post-diagnosis must be considerable.

In today's world, it could be reasonably argued that depression is a side effect of adulthood.

However, speaking as someone who has had major depressive disorder, I can attest to the vast difference between that condition that the depression/suicidal tendencies due to HIV drugs (namely efavirenz/Sustiva.)

The suicidal thoughts came out of nowhere. I had HAD HIV for over a decade at the time. I had lost basically everything that created an adult persona in today's society. I was used to the PTSD that comes with that. But the drug chemically altered my perceptions. It did so to such a dramatic degree that I was cognitively aware that my perceptions were altered. Such is rarely the case with situational or genetic depression.

My doctor at the time was not well-versed in the CNS effects of that drug. These effects were purposefully withheld and downplayed by the pharmaceutical company, and at the time (2002 I believe) the doctor was simply disregarding patient reports in his office. He wanted me to stay on the drug in question, and instrad put me on an insanely high dose of Welbutrin, which did nothing to allieviate the situation but added a level of anxiety that almost caused me to follow through with the ideation.

Common sense prevailed, and I fired that doctor, stopped the drugs (what idiot dispenses antidepressants without referring a patient to therapy) and found another infectious disease specialist. I have been that that office ever since, and have not looked back. It took all of a WEEK for my suicidal ideations to subside once I quit the Sustiva.  The anxiety from the Welbutrin took longer, and I sometimes wonder if that's not just become A Thing.

So the dance between HIV and depression is a pretty intricate one. Has HIV fucked with my head? Absolutely. From the moment of diagnosis to the loss of, well, over teo thirds of my age group, to the meds used to combat it.

Therapy has helped, from time to time. Your level of competance in the therapy world has a lot to do with the insurance you have. Medicare? Enjoy educating a post-doc student, and in a pinch, helping her over her abusive gay ex-husband.

I fight to roll my eyes when I hear about the "adjustment period" regarding HIV infection. I have been positive since 1993. The "adjustment period" is any time HIV presents an obstacle. Dating? Check. Work? Check. Dealing with life's changes? Oh yeah, HIV weighs in there too. The adjustment period is, on levels both subliminal and overt, the rest of your life.

Disclosure, medical issues, financial/insurance stuff, peer stuff, it all impacts a person. The cumulation of all that is a recipe for situational depression. Recognizing that is a great first step towards differentiating situational, genetic, and chemcial imbalance. Knowing the difference can literally save your life.

It's saved mine more than once.

monarcmarc:
I hear what you're saying in relation to adjustment period. Thanks for not rolling your eyes.

The thing is, what I hope for myself, and I might be naive, is that with experience and support in dealing with those obstacles I become better equipped to deal with them so that it is just rolling with the punches, and is a part of my life, just as any other aspect of my life is a part of my life. I've recently moved a great distance geographically, and to me, as much as I've been having some issues with meds, (and I still haven't ruled out that my desire to change is simply trying to rebel against something that needs to be part of my life that I've not yet come to terms with) I find that the move itself has had much more of a toll on me emotionally.

I've been very fortunate in that while I might have made poor decisions prior to my diagnosis and am still prone to making them, I think it's had a significant impact on my ability to see what are the right decisions for me to make. I don't know whether I'm alone there, but I seek out more satisfying and rewarding activities, even though there may be more stress involved than had I taken the 'easy' path of instant, no consideration for consequences, gratification.

Thanks for sharing your thoughts on this.
 

jkinatl2:
Getting the tools you need to deal with the problems will absolutely help. But please don't think there's a time when you ought to be "better."

Better is like Happy. Not something you can aspire to, really. some thing to enjoy when it's there.

I just urge you to be gentle with yourself. Adjustment is something we do forever. If you are lucky, strong, and/or appropriately medicated, it's possible to power through the hard parts.

Say: Disclosure. It's become a lot easier for me and my partners, obviously. But then you meet the in-laws, and a mindset from the 80s about HIV. Suddenly it's a Big Thing. Again. And it's perfectly OK to lose sleep over it.

I remember when my current BF's parents found out about my HIV status. Mainly by Googling my name and finding my poz.com blog. And of course their worry was for their son, that notion of Undetectable Virus in the blood as opposed to possible viral spikes in the semen. Which meant someone had to reassure them that... well, and it pretty much goes to a series of X-rated diagrams about our sexual likes from there on. Which is something I have yet to see in any other form of relationship.

So, it reasserts itself in the most unlikely places. And with it, the self-questioning and the uncertainty.

The tools we get through therapy and (in some cases) life experience might help mitigate these situations, but there's no avoiding them. We deal with HIV every time. Hopefully, we do it with a semblence of grace or dignity. On our best days we avoid swear words.

positivelynerd:
Mark,

I've toiled with this idea as well.  For me, it was a month between diagnosis and meds, so I was definitely still dealing with the initial shock of it all when I started on Sustiva.  Things have absolutely gotten better, but I haven't been without my dark days.  How much of it is me?  My situation?  My drugs?  I don't think I'll ever know, they're too tangled together.

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