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 than the general population. This could be 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 because of the added pressures they can live with.

Having a weak immune system and low CD4 cell count  because of HIV is known to increase the risk of developing some infections which involve mental health problems. Thanks to HIV treatment,  these are now very rare.

But many people with HIV report being unhappy, sad, anxious, or unable to cope. Some anti-HIV drugs can also cause side-effects that affect the brain.

HIV-related mental disorders

It is estimated that before HIV treatment became widely available, 7% of people with advanced HIV infection developed dementia.  Mania has also been observed in people with advanced HIV disease.

It is highly unusual for a person who is taking 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 an illness and is twice as common in people with HIV as in the general population.

Depression can be triggered by ill health or social problems. But sometimes it's difficult to be sure what the cause is. It is characterised by having 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-worth; 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 that 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 the first time you've developed depression 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, also in the combination pillAtripla) can cause psychological problems. Some people have difficulty sleeping, or vivid dreams or nightmares. Other people have reported depression without any other apparent cause.

Taking interferon treatment for hepatitis C infection can also cause mental health problems, particularly depression.

Doctors often prescribe antidepressants if they think that depression might be a treatment side-effect.

Anxiety

Anxiety is a feeling of panic or worry. Often, people report symptoms such as  as sweating, rapid heart beat, agitation, nervousness, headaches and panic attacks. Anxiety can accompany depression or be seen as a disorder by itself. It is often caused by feeling fearful, insecure, or uncertain.

Talking through the reasons for your anxiety and your feelings of anxiety with a friend or a counsellor 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 used along with special kinds of psychological therapy. Examples include psychotherapy, and cognitive behavioural therapy (CBT), both of which usually involve a short course of sessions with a psychotherapist or psychologist.

Where to go for help and support

A good place to start would be your HIV clinic. Your HIV doctor should take your mental health as seriously as your physical health. Many of the larger HIV clinics have expert HIV mental health teams.

The following counselling and mental health organisations may also be useful.

PACE

PACE provides counselling for gay men and lesbians for issues including HIV.

020 7700 1323

http://www.pacehealth.org.uk/

Saneline

UK mental health charity

Helpline 0845 767 8000

http://www.sane.org.uk/

Mind

UK mental health charity

Mind Info Line 0845 766 0163

http://www.mind.org.uk/

Samaritans

Confidential emotional support 24 hours a day

08457 90 90 90

http://www.samaritans.org