Updated February 2013
Studies have shown that, in the general population, women are two times more likely to be depressed than men. While it is not clear why women suffer from depression so much more than men, there are several possible reasons. One reason used to explain the high rate of depression among women is the burden many women bear as the primary caregiver for family members. Often, women will care for others and not care properly for themselves. Other reasons that women may feel depressed include having a lower household income, less education, less social support, and a greater chance of being physically and/or sexually abused.
Women living with HIV (HIV+) are even more likely to suffer from depression than women in the general population. Although many HIV+ people live long, healthy, and full lives, learning that you are HIV+ is life-changing news that can be very difficult to hear and accept. Some people feel overwhelmed, helpless, or unable to cope with an HIV diagnosis. Others are afraid for their future health, or of disclosing their HIV status to friends and family. The stigma that many HIV+ women experience may lead to social isolation and feelings of loneliness. All of these feelings – helplessness, anxiety, loneliness – are key elements of depression.
Many HIV+ women also experience large life stressors such as racial discrimination, poverty, violence, and single parenthood, which can lead to depression. An HIV diagnosis can simply add to this burden and to the chances of developing depression.
As HIV treatments have improved, there are more and more older women living with HIV. Growing older often involves its own life challenges, such as chronic disease, disability, or the loss of loved ones. These life changes can lead to feelings of sadness or depression. One study showed that more than six in ten HIV+ women from 50 to 76 years old suffered from depression.
Studies show that there is a direct connection between depression and reduced health for those living with HIV. Specifically, HIV+ women who are depressed seek HIV care less often, have more trouble sticking with their HIV drug regimens, and have more rapid disease progression. If you are experiencing symptoms of depression, you may miss doses, take the wrong dose, or take the dose at the wrong time. Not taking your HIV drugs regularly can lead to the development of resistance, which makes HIV drugs less effective at fighting the virus. This can cause your CD4 cells to go down and/or your viral load to go up.
Even among HIV+ women with similar CD4 counts and viral loads, being depressed can double the likelihood of dying compared to having few or no symptoms of depression. For those women who made contact with a mental health provider, the risk of death was cut in half. It is important that depression be diagnosed and treated as quickly as possible to avoid serious problems.
Being depressed, in everyday language, occurs when someone feels down, sad, blue, unhappy, or hopeless. These are all normal feelings, and almost everyone experiences them at one time or another. Receiving and living with a diagnosis of HIV can be stressful, overwhelming, and fearful at times. So it is not unusual for HIV+ people to feel down or anxious.
If these feelings are overpowering, disabling, or long-lasting, however, they may be a sign that you are experiencing a condition known as depression. Compared to sadness, depression is more intense, lasts longer (more than two weeks), and interferes with your day-to-day ability to function. In medical language, depression is a diagnosis based on having a certain number of specific symptoms (from the list below). Depression is not a normal part of being HIV+ and can cause some serious health problems. If you have any of these symptoms or are unsure if what you are experiencing is normal, it is important to talk to your health care provider.
Symptoms of depression include:
- Changes in appetite or weight
- Aches or pains for no clear reason
- Feelings of sadness, guilt, hopelessness, and/or worthlessness
- Irritability; getting into arguments easily
- Lack of interest or pleasure in activities that usually interest you
- Low sex drive
- Difficulty making decisions or concentrating
- Changes in sleep patterns
- Fatigue or loss of energy
- Thoughts of harming oneself or committing suicide
If you are thinking of hurting yourself of committing suicide, please tell someone immediately. You can call 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255) or go to http://suicidehotlines.com/.
In addition to the symptoms listed above, you may also notice yourself doing some of the following if you are depressed:
- Not taking care of yourself in terms of grooming, dressing, and personal hygiene
- Skipping or not going to work; calling in sick
- Being very critical and down on yourself
- Not talking to or going out with friends
- Not pursuing doing your usual social activities, hobbies, or recreations
- Crying or feeling like crying more often than normal, and often without knowing why
- Using alcohol or other recreational drugs more than usual
Sometimes substance use hides depression. This happens when people try to “self-medicate” by using drugs or alcohol to try not to feel the pain of what troubles them. If you feel that depression or anxiety causes or adds to your substance use, ask your health care provider or AIDS service agency for a referral to a mental health provider.
The good news is that depression is treatable. Treatments include psychotherapy, social support, medication, alternative therapies, or any combination of these. While it is true that depression can get better on its own, this can take months or even years. Treatment will likely shorten the time it takes for you to feel better and may help you stay on your HIV drugs. It also may keep you from losing a job, a relationship, or even your life.
Various mental health professionals can provide psychotherapy, also known as “talk therapy” or personal counseling. Psychotherapy involves talking to a trained professional about what you are experiencing. The therapist provides support and helps you to understand what is troubling you. While most psychotherapy occurs one-on-one, group therapy is also helpful for some people.
In the US, mental health professionals who provide psychotherapy include:
- Social workers
- Marriage and family therapists
- Mental Health Counselors
It may also be helpful to seek the support of other HIV+ women through support groups or peer counseling (Please visit our online blog for HIV+ women, A Girl Like Me). Social support from friends and family has been found to help HIV+ people avoid depression or cope better with it. Contact with others helps prevent feeling lonely and isolated. Friends and family can also provide emotional support, which is very important for people living with a serious illness like HIV. Members of a social support network can help with chores like shopping or housework and act as caregivers if you get sick.
Antidepressant medications are often prescribed for depression or anxiety and have been shown to help decrease symptoms for some people. Care should be used when taking antidepressant medications with HIV drugs. Many of the popular kinds of antidepressant and anti-anxiety drugs can interact with some HIV drugs. It is important to talk to your health care provider before starting any new medications.
Generally, the safest type of antidepressants for use with HIV drugs is selective serotonin re-uptake inhibitors or SSRIs, such as Celexa (citalopram), Lexapro (escitalopram), Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline). A popular herbal antidepressant called St. John’s Wort should not be taken, as it affects the immune system and interacts with many HIV drugs.
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. Mindfulness techniques may help you get back in touch with what makes life worth living and avoid going into downward mood spirals. Some of them have even been combined with traditional psychotherapy and shown to be very effective (e.g., mindfulness-based cognitive therapy). Good nutrition and physical activity are beneficial, no matter which treatments you choose.
Talk to your health care provider about depression, especially if you are experiencing symptoms or having trouble sticking to your HIV drug regimen. If you are suffering from depression, ask for a referral to see a mental health care provider. Mental health care (including psychotherapy, social support, medication, and alternative therapies) can not only improve your adherence to HIV drugs, but also improve your health and quality of life.
Many people do not believe in the value of mental health treatment. You or those you love may have heard that people who see therapists or take antidepressants are “crazy,” or weak. Try not to let these judgments keep you from getting treatment that will make you feel and live better. When we experience physical problems, it is best to get treatment. If someone breaks her leg, we encourage her to see a health care provider to get the leg checked and treated so it heals properly. Similarly, when we experience emotional difficulty, there is no need to suffer when effective treatment is available.