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Depression, anxiety and emotional distress
Depression
People often say that they are ‘depressed’ when they are feeling down. Often what they are experiencing is a natural fluctuation in mood, or an appropriate reaction to a distressing event or situation.
Depression is an illness, and doctors often talk about ‘clinical depression’ or ‘major depression’ because of this. It is thought that depression occurs much more frequently in people with HIV than in the general population. In a recent survey of people with HIV in the UK, two thirds of respondents said that they had experienced depression at least once in the year before. It is also worth remembering that gay men and Africans, the two groups most affected by HIV in this country, already have higher rates of depression than the general UK population.
HIV doctors are very used to seeing people with depression, and many of the large HIV clinics have specialist mental health teams including psychiatrists, psychologists and mental health nurses.
Causes of depression can vary between people. Illness, unbearable stress and social problems often cause depression to develop, and it has been suggested that some people may be genetically more prone to depression than others. In many cases, however, there might be no identifiable cause for the depression.
Depression is characterised by the presence of some or all of the following symptoms for some or all of the time for a period of weeks or even months:
If you think you have symptoms of depression it is important to get help. Try talking to your partner, a friend or a family member about how you feel. If you think you need professional help, contact one of the organisations listed at the back of this booklet and on page 19. Your GP or HIV doctor will also be able to help. Nobody will think that you are weak, unstable or ‘mad’ if you ask for help because you think you might be depressed.
Seek help immediately if you are thinking of harming or killing yourself.
If you have depression, your doctor may recommend that you take a type of medicines called antidepressants. These drugs relieve the symptoms of depression by correcting chemical imbalances in the brain. They can take between four and twelve weeks to have an effect, and like all medicines, can have side-effects.
There are three main classes of antidepressant drugs called tricyclics, MAOIs and SSRIs. If your doctor prescribes an antidepressant, it is most likely that it will be from the SSRI (selective serotonin re-uptake inhibitor) class. Drugs in this class, which include fluoxetine (ProzacTM) have fewer side-effects and interactions with other medications. In particular, the antidepressant Cipramil (citalopram) is often used because it has few interactions with anti-HIV drugs.
Make sure that you tell your HIV doctor and pharmacist if you have been prescribed an antidepressant.
SSRI antidepressants do however have side-effects, particularly in the first few weeks. Side-effects at this time can be particularly difficult to cope with because antidepressants often need to be taken for several weeks before they start to relieve the symptoms of depression.
The herbal antidepressant St John’s wort interacts with protease inhibitors and NNRTIs leading to low levels of the anti-HIV drugs in the blood, risking the development of drug resistant HIV. For this reason you must not take St John’s wort if you are taking a protease inhibitor or an NNRTI.
The amount of time you stay on antidepressants will vary with your individual circumstances. You may well start to feel a lot better a few weeks after you start taking them, but it is generally recommended that you remain on antidepressants for at least three months if you are taking them to treat your first depressive illness, or longer if a recurrence in your depression has occurred.
To prevent withdrawal symptoms occurring, you may have to reduce the dose of the antidepressant you are taking over a period of weeks before you stop taking it completely.
There is good evidence that antidepressants work better if accompanied by talking therapies designed to help you understand and control your depression. Cognitive behavioural therapy is one example. It usually involves a short course of sessions with a psychologist where you will have an opportunity to explore the origins and warning signs of your depression, and learn skills to control it.
There is some evidence that manic depression (a combination of uncontrollably high moods followed by depression) is slightly more common in people with HIV, possibly associated with the onset of illness related to HIV or the commencement of anti-HIV treatment. Drugs can help correct chemical imbalances in the brain associated with these mood swings and cognitive behavioural therapy can help provide the skills to recognise the warning signs and triggers for mood swings.
Anxiety
Anxiety is a feeling of panic or apprehension. It can be a very appropriate and useful reaction in certain circumstances when it is the body’s natural response to a threat or challenge. However, many people have long-term problems with anxiety which interferes with their ability to get on with their daily life.
Symptoms of anxiety can include sweating, rapid heart rate, agitation, nervousness, headache, and panic attacks. It often occurs along with symptoms of depression, and can also happen by itself.
Post-traumatic stress disorder is sometimes experienced by people with HIV. This occurs when a person has experienced a traumatic event which the memory is unable to process properly. This can cause flashbacks, nightmares, and nervousness.
If your anxiety is caused by practical problems, then getting practical advice about how to approach these difficulties may well provide a solution. Counselling may also prove useful, and a short course of cognitive behavioural therapy with a psychologist can help provide the skills to understand the origins of anxiety and to control it.
Anxiety which occurs alongside depression is often successfully treated by antidepressants.
Massage, acupuncture, other complementary therapies and exercise can all relieve the symptoms of anxiety.
Drugs such as benzodiazepines, including ValiumTM, used to be widely prescribed for the treatment of long-term anxiety. Their use is now restricted because they are addictive. However, they are still used to treat short-term periods of anxiety without any risk of addiction.
Emotional distress
Particular events, such as being diagnosed with HIV, the breakdown of a relationship, bereavement, being ill, dealing with side-effects, or work problems can cause feelings of deep unhappiness and emotional distress.
Feelings can include denial, anger, and sadness and these can last for weeks or months before there is an acceptance of the new situation. This is often referred to as a 'grieving process.'
Support from friends and family can be very helpful at this time. Professional help is also available. Your HIV clinic may be able to arrange a short-term course of counselling, and some HIV support agencies also offer similar services. Trained staff at specialist helplines may also be supportive.
Complementary therapies, such as acupuncture and massage can help relieve the symptoms of emotional distress.
If you find that your feelings are more than you can cope with, or are interfering with your ability to get on with your daily life, make sure that you mention this to a member of your healthcare team. Help is available.
People often say that they are ‘depressed’ when they are feeling down. Often what they are experiencing is a natural fluctuation in mood, or an appropriate reaction to a distressing event or situation.
Depression is an illness, and doctors often talk about ‘clinical depression’ or ‘major depression’ because of this. It is thought that depression occurs much more frequently in people with HIV than in the general population. In a recent survey of people with HIV in the UK, two thirds of respondents said that they had experienced depression at least once in the year before. It is also worth remembering that gay men and Africans, the two groups most affected by HIV in this country, already have higher rates of depression than the general UK population.
HIV doctors are very used to seeing people with depression, and many of the large HIV clinics have specialist mental health teams including psychiatrists, psychologists and mental health nurses.
Causes of depression can vary between people. Illness, unbearable stress and social problems often cause depression to develop, and it has been suggested that some people may be genetically more prone to depression than others. In many cases, however, there might be no identifiable cause for the depression.
Depression is characterised by the presence of some or all of the following symptoms for some or all of the time for a period of weeks or even months:
- Low mood.
- Apathy.
- Poor concentration.
- Irritability.
- Difficulty sleeping.
- Waking up early.
- Oversleeping constantly.
- Inability to relax.
- Changes in eating habit, such as loss of appetite or overeating.
- Weight loss or weight gain.
- Lack of pleasure from usually enjoyable activities.
- Feelings of low self-worth.
- Inappropriate and excessive feelings of guilt.
- Thoughts of death, self-harm, or suicide.
If you think you have symptoms of depression it is important to get help. Try talking to your partner, a friend or a family member about how you feel. If you think you need professional help, contact one of the organisations listed at the back of this booklet and on page 19. Your GP or HIV doctor will also be able to help. Nobody will think that you are weak, unstable or ‘mad’ if you ask for help because you think you might be depressed.
Seek help immediately if you are thinking of harming or killing yourself.
If you have depression, your doctor may recommend that you take a type of medicines called antidepressants. These drugs relieve the symptoms of depression by correcting chemical imbalances in the brain. They can take between four and twelve weeks to have an effect, and like all medicines, can have side-effects.
There are three main classes of antidepressant drugs called tricyclics, MAOIs and SSRIs. If your doctor prescribes an antidepressant, it is most likely that it will be from the SSRI (selective serotonin re-uptake inhibitor) class. Drugs in this class, which include fluoxetine (ProzacTM) have fewer side-effects and interactions with other medications. In particular, the antidepressant Cipramil (citalopram) is often used because it has few interactions with anti-HIV drugs.
Make sure that you tell your HIV doctor and pharmacist if you have been prescribed an antidepressant.
SSRI antidepressants do however have side-effects, particularly in the first few weeks. Side-effects at this time can be particularly difficult to cope with because antidepressants often need to be taken for several weeks before they start to relieve the symptoms of depression.
The herbal antidepressant St John’s wort interacts with protease inhibitors and NNRTIs leading to low levels of the anti-HIV drugs in the blood, risking the development of drug resistant HIV. For this reason you must not take St John’s wort if you are taking a protease inhibitor or an NNRTI.
The amount of time you stay on antidepressants will vary with your individual circumstances. You may well start to feel a lot better a few weeks after you start taking them, but it is generally recommended that you remain on antidepressants for at least three months if you are taking them to treat your first depressive illness, or longer if a recurrence in your depression has occurred.
To prevent withdrawal symptoms occurring, you may have to reduce the dose of the antidepressant you are taking over a period of weeks before you stop taking it completely.
There is good evidence that antidepressants work better if accompanied by talking therapies designed to help you understand and control your depression. Cognitive behavioural therapy is one example. It usually involves a short course of sessions with a psychologist where you will have an opportunity to explore the origins and warning signs of your depression, and learn skills to control it.
There is some evidence that manic depression (a combination of uncontrollably high moods followed by depression) is slightly more common in people with HIV, possibly associated with the onset of illness related to HIV or the commencement of anti-HIV treatment. Drugs can help correct chemical imbalances in the brain associated with these mood swings and cognitive behavioural therapy can help provide the skills to recognise the warning signs and triggers for mood swings.
Anxiety
Anxiety is a feeling of panic or apprehension. It can be a very appropriate and useful reaction in certain circumstances when it is the body’s natural response to a threat or challenge. However, many people have long-term problems with anxiety which interferes with their ability to get on with their daily life.
Symptoms of anxiety can include sweating, rapid heart rate, agitation, nervousness, headache, and panic attacks. It often occurs along with symptoms of depression, and can also happen by itself.
Post-traumatic stress disorder is sometimes experienced by people with HIV. This occurs when a person has experienced a traumatic event which the memory is unable to process properly. This can cause flashbacks, nightmares, and nervousness.
If your anxiety is caused by practical problems, then getting practical advice about how to approach these difficulties may well provide a solution. Counselling may also prove useful, and a short course of cognitive behavioural therapy with a psychologist can help provide the skills to understand the origins of anxiety and to control it.
Anxiety which occurs alongside depression is often successfully treated by antidepressants.
Massage, acupuncture, other complementary therapies and exercise can all relieve the symptoms of anxiety.
Drugs such as benzodiazepines, including ValiumTM, used to be widely prescribed for the treatment of long-term anxiety. Their use is now restricted because they are addictive. However, they are still used to treat short-term periods of anxiety without any risk of addiction.
Emotional distress
Particular events, such as being diagnosed with HIV, the breakdown of a relationship, bereavement, being ill, dealing with side-effects, or work problems can cause feelings of deep unhappiness and emotional distress.
Feelings can include denial, anger, and sadness and these can last for weeks or months before there is an acceptance of the new situation. This is often referred to as a 'grieving process.'
Support from friends and family can be very helpful at this time. Professional help is also available. Your HIV clinic may be able to arrange a short-term course of counselling, and some HIV support agencies also offer similar services. Trained staff at specialist helplines may also be supportive.
Complementary therapies, such as acupuncture and massage can help relieve the symptoms of emotional distress.
If you find that your feelings are more than you can cope with, or are interfering with your ability to get on with your daily life, make sure that you mention this to a member of your healthcare team. Help is available.