Facing Depression in HIV

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Finding a therapist When looking for a therapist, many people feel intimidated and don't know where to begin. In addition to the referral sources mentioned above, be creative. Ask your friends or family, if you're comfortable with sharing your need with them, or ask some of the services available at many community based organizations (CBOs) such as Gay Men's Health Crisis (GHMC) or the Gay and Lesbian Community Center. There are resources available for all types of people. You may be concerned about whether or not their mental health professional will be familiar with the issues associated with HIV. At this point in the epidemic, there are mental health professionals who sub-specialize in treating people with HIV, so it is possible, but not essential, to find such a therapist. While a specialist in HIV-related depression is not absolutely essential, it is extremely important to seek a therapist at least somewhat familiar with, if not an expert in, the physical and emotional complications of HIV, and also familiar with the environments and cultures which comprise high risk populations. Often, those at risk for HIV are more vulnerable to issues of stigma and thus more reluctant to seek mental healthcare. Many potential patients or clients are concerned that, in seeking therapy or a consultation, they will be confronted with some of the traditional, but antiquated, prejudices of the mental health profession, such as prejudices against homosexuality. It is definitely outside the mainstream of accepted clinical practice to view homosexuality pathological or to try to change and individual's sexual orientation. Doing so is counter-therapeutic and often leads to worsening of depressive symptoms.

When consulting with a mental health professional, it is important to consider several factors. Foremost, you should feel that the person is a good listener. If your therapist doesn't hear you, you'll get nowhere. You should feel comfortable being with the therapist. That person should be able to answer your questions, be open to your theories and ideas, ask good questions that stimulate your thinking and self-reflection, and be someone with whom you feel you can work and can trust. Therapy is a collaborative effort. It is reasonable to interview several candidates to be your therapist. Note, however, that it's probably your issue if, after more than a small handful of candidates, you can't find anyone to work with.

Antidepressants

Combining psychotherapy with medication is generally considered the optimal treatment for depression. Quite often, medication is the most readily accessible treatment for most people with HIV and a depressive disorder. Many of the currently available antidepressants have been studied in people with HIV or AIDS and all have been shown to be safe and effective. A primary care provider can often initiate treatment with an antidepressant. Ongoing treatment should, however, be supervised by a psychiatrist familiar with HIV treatments and potential pharmacologic interactions. Only people with a medical degree, an MD, can prescribe medications. If you're working with a psychologist (PhD) or social work therapist (LCSW), that person should have a working relationship with a psychiatrist who is available to you for medication consultation.

The decision to seek medication treatment should be collaborative, but it's not unusual for the HIV-positive individual in psychotherapy to resist taking steps that could lead to going on yet another medication. Consider your initial consultation with a psychiatrist as information gathering. Get her opinions about your problems and how medications may be helpful. Feel open about discussing this information with your regular therapist. Because so many people with HIV are on some form of antidepressant, many people prefer to work with a psychiatrist, as opposed to a psychologist, as a way of minimizing their number of providers. Most psychiatrists also do psychotherapy and are quite interested in providing this service in combination with medication management.

Conclusion

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Major depression is a serious clinical disorder. It is not part of having HIV, but in mild forms, some of its signs and symptoms may reflect a natural adjustment to HIV as a diagnosis or illness. As with many illnesses, early detection usually leads to more rapid and complete treatment. In the end, getting treatment is your choice. The mode or combination of treatments you choose is also your choice. If your are uncertain about your feelings, changes in emotions, energy, or interests, having thoughts of death or suicide, open up to your healthcare provider. Listen to your friends and family when they say, "Maybe you should seek treatment." The information and help you get may greatly add to your quality of life or even save your life.

Next: Choosing a healthcare provider for HIV treatment

Last updated: 10/05

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