Depression is a serious problem for many HIV+ women. In fact, studies show that almost 60 percent of HIV+ women display clinical signs of depression and up to 75 percent display at least some depressive symptoms. HIV+ women are 20 percent more likely to be depressed than HIV+ men.

Many factors contribute to the high rate of depression among HIV+ women. Experts believe that lower household income, active drug use, alcohol use, and sexual and physical abuse may all add to the risk. Relationship status and social support may also be related to depression.

While scientists have linked chronic depression in women with a decline in CD4 cells, the specific connection is still unclear. However, clinical depression is one of the leading causes of non-adherence to HIV medications.

If you are experiencing depressive symptoms, you may be more likely to miss doses, take the wrong dose, or take the dose with the wrong food or at the wrong time. Non-adherence can lead to the development of resistance, which causes the HIV medications to be less effective at fighting the virus. This can cause your CD4 cells to go down and/or your viral load to go up.

Studies have shown that HIV+ women with depression are twice as likely to die as those with few or no depressive symptoms. Clearly, it is important that depression be diagnosed and treated as quickly as possible so that a more positive outcome can be achieved.

Symptoms of depression include:

• Changes in appetite or weight
• Aches or pains
• Feelings of sadness, guilt, and/or low self-worth
• Irritability
• Lack of interest or pleasure in activities
• Low sex drive
• Thoughts of self-harm or suicide
• Difficulty making decisions or concentrating
• Changes in sleep patterns
• Fatigue or loss of energy

Some of the early signs of depression can be similar to those of HIV, making diagnosis more complex. Depression can also be confused with sadness. But compared to sadness, depression is more intense, lasts longer, and interferes more with your day-to-day functioning. Depression is not a normal part of being HIV+ and it is important to report any of the above-mentioned symptoms to your medical provider and discuss treatment options.

Sometimes substance use can mask depression. This happens when people try to “self-medicate” by using drugs or alcohol to make their problems go away. If you feel that an underlying issue, such as depression or anxiety, causes or contributes to your substance use, ask your doctor or AIDS service agency for a referral to a mental health professional.

The good news is that depression is very treatable. Treatments include psychotherapy, medication, alternative therapies, or any combination of the three.

Various mental health professionals can provide psychotherapy, including psychologists, psychiatrists, and social workers. It may also be helpful to seek the support of other HIV+ women through support groups or peer counseling.

Antidepressant medications are often prescribed for depression or anxiety and have been shown to help decrease symptoms. Caution should be used when combining HIV medications with those for depression. Many of the popular kinds of antidepressant and anti-anxiety drugs can interact with some HIV medications.

Generally, the safest class of antidepressants for use with HIV medications is selective serotonin re-uptake inhibitors (SSRI’s) such as Prozac, Zoloft, and Serzone. Popular herbal preparations used for depression that include St. Johns Wort should not be used with HIV medications. 

Meditation, massage, yoga, breathing and relaxation exercises are all alternative therapies that may help you feel better. Acupuncture and acupressure therapies may help reduce stress and improve your mood. Good nutrition and exercise are beneficial, no matter which treatments you choose. Also have your testosterone level checked. Low testosterone can cause depression.

Many people, including members of some racial and ethnic minority groups, are skeptical about the value of mental health treatment. Even if you have heard family and friends say that people who see therapists or take antidepressants are “crazy” or weak, try not to let these prejudices prevent you from getting treatment that will make you feel and live better.

1		Boggs, W. (2002). Depression Impairs adherence to HAART regimen by HIV-infected women: Retrieved May 2003 from http://www.hivandhepatitis.com/recent/women/081402d.html
2		Ickovics, J. et. al. (2001). Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women. Journal of the American Medical Association 285(11). 1466-1474.
3		Sorenson, S.J. et. al. (2002). Gender related factors influencing medication and clinical visit adherence in HIV/AIDS patients. International AIDS Conference, Barcelona. Abstract WePeB5856XIV.