Mental health problems can affect anybody and do affect many people at some point in their lives. But, people with HIV are more likely to experience mental health problems than the general population. This could be because the groups most affected by HIV in the UK – gay men, refugees, 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.
HIV-related mental disorders
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.
Particular events such as receiving an HIV diagnosis, the breakdown of a relationship, bereavement, 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 day-to-day life.
Support from family and friends can be very helpful at these times, as can support from other people with HIV, and professional help, such as counselling and psychotherapy. 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.
Depression is thought to be around twice as common in people with HIV as in the general population. Many people get better from a period of depression without professional help. Talking through feelings and taking good care of yourself, by making sure you get enough sleep, exercising and eating well, can make a big difference.
Sometimes it’s difficult to be sure what the cause is, but depression 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 mood 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.
You must not take the herbal antidepressant St John’s wort if you are taking certain anti-HIV drugs, as it can reduce their effectiveness. Talk to your doctor if you have been taking St John’s wort, or are planning to.
The amount of time you stay on antidepressants will vary according to 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 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 pill Atripla) can cause psychological problems. Some people have difficulty sleeping, or vivid dreams or nightmares. Another anti-HIV drug, rilpivirine (Edurant, also in the combination pill Eviplera) may also cause depression and mood changes. Other people have reported depression without any other apparent cause. If you think you are suffering from depression now, or have done in the past, it is important to talk to your doctor about this when deciding on the best HIV treatment options for you.
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 is a feeling of panic or worry. Often, people report symptoms such as sweating, rapid heartbeat, agitation, nervousness, headaches and panic attacks. Anxiety can accompany depression or may occur by itself. It is often caused by feeling fearful, insecure, or uncertain.
Talking through your feelings of anxiety and the reasons for it with a friend or a counsellor might be helpful. Anxiety which accompanies depression may be 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 because they are addictive. However, they are still used in the treatment of short periods of acute anxiety without any long-term dependency problems.
Often drug therapies for mental health 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 just as seriously as your physical health. Many of the larger HIV clinics have expert HIV mental health teams. There are also many HIV support organisations – your HIV clinic will be able to tell you about local support, or you can use our online database to search for organisations. Visit www.aidsmap.com/e-atlas.
The following counselling and mental health organisations may also be useful.
- PACE (020 7700 1323) PACE provides counselling and psychotherapy for gay men and lesbians in London, for issues including HIV. There is usually a fee for these sessions. Visit their website at: www.pacehealth.org.uk
- SANELINE (Helpline 0845 767 8000) UK mental health charity. Visit their website at:www.sane.org.uk
- Mind (Mind Info Line 0300 123 3393) UK mental health charity. Visit their website at:www.mind.org.uk
- Samaritans (08457 90 90 90) Confidential emotional support 24 hours a day. Visit their website at: www.samaritans.org