Mental-health issues

In this section you will find information about

HIV and mental health
HIV-related mental health problems
Emotional distress
Depression
Anxiety
Mental health problems as a side effect of anti-HIV treatment
Looking after your mental health

HIV and mental health

Good mental health is important to everybody. It is an integral part of good overall health for people with HIV and issues such as emotional distress, anxiety and depression should not be treated as a secondary health concern.

Significant improvements in HIV treatment mean that people with HIV are now living longer lives. However, if you are living with a long-term illness, which is still highly stigmatised, it means that issues such as uncertainty about the future, side effects, pain, fear of future disease progression and fear of discrimination can still cause emotional strain and have mental health implications.

It is therefore important for people living with HIV to have information about the ways in which HIV can affect their mental health and about common mental health issues such as depression, anxiety and emotional distress.

HIV-related mental health problems

Before effective anti-HIV treatment became available it was estimated that around 7% of people with advanced HIV infection would develop dementia. Mania has also been observed in people with HIV disease. It is highly unusual for someone who has been treated with ant-HIV drugs to develop either of these conditions as a result of being HIV positve.

Symptoms of dementia in HIV positive people resemble those seen in older people with senile dementia. They include:

Difficulty in thinking or understanding, including forgetfulness, loss of memory, severe problems concentrating, confusion and problems planning or organising.
Behavioural changes including feelings of isolation, a loss of interest, and childish behaviour.
Problems with movement and coordination, such as loss of balance or strength from the limbs.
There can, of course, be many other causes of these symptoms. It is therefore important to see your HIV doctor to find out what the cause is if you have any of these symptoms.

Any potent anti-HIV therapy combination that keeps your CD4 cell count above 200 will protect you from developing dementia. It will also protect you from mania (episodes of uncontrolled impulses, or bursts of energy or rage) which is occasionally seen in people with very advanced HIV infection with a CD4 count below 50.

Emotional distress

Being diagnosed with HIV and other distressing events such as the breakdown of a relationship, bereavement, being ill, dealing with side-effects of treatment, or work problems can cause feelings of deep unhappiness and emotional distress.

Feelings can include denial, anger, and sadness, which 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. Support is also available from trained Support Workers at ACET Jersey. The Sexual Health Clinic may also be able to arrange a short-term course of counselling. Trained staff at specialist helplines may also be supportive.

Complementary therapies, such as massage can also help relieve the symptoms of emotional distress.
If you find your feelings start to overwhelm you, or start to interfere with your ability to cope with daily life discuss this with a member of your healthcare team. Help is available.

Depression

People often use the word depression to describe a natural fluctuation in mood, or an appropriate reaction to a distressing event or situation.

Clinical depression is an illness, which is thought to occur much more frequently in people with HIV than 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 previous year.

It is also true that gay men and Africans, the two groups most affected by HIV in the UK, already have higher rates of depression than the general UK population.

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
Constantly oversleeping
Difficulty relaxing
Changes in eating habits such as loss of appetite or overeating
Weight loss or weight gain
Lack of pleasure in 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 the symptoms of depression it is important to get help. Talk to your partner, a friend or a family member about how you feel. Your HIV doctor or GP will also be able to help. No one will think that you are weak, unstable or ’mad’ if you ask for help because you think you may be depressed.

Seek help immediately if you are thinking of harming or killing yourself.

Your doctor may recommend that you take antidepressants, which 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.

It is likely that you will be prescribed a drug from the SSRI (selective serotonin re-uptake inhibitor) class, which have fewer side-effects and interactions with other medications. Drugs in this class include fluoxetine (Prozac). In particular, the antidepressant citalopram (Cipramil) is often used because it has few interactions with anti-HIV drugs.

Make sure you tell your ~HIV doctor and pharmacist if you have been prescribed an antidepressant.

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 of your depression has occurred.

There is no evidence that SSRI antidepressants are addictive. But you may experience withdrawl symtms if you suddenly stop taking paroxetine (Seroxat). To prevent this happening, you may have to reduce the dose of this drug over a period of weeks before you stop taking it completely.

Ther is good evidence that antidepressants are more effective if accompanied by talking therapies designed to help you understand and control your depression. Cognitive behaviour therapy is one example. It usually involves a short course of sessions with a psychologist where you will have the opportunity to explore the origins and warning signs of your depression, and learn skills to control it.

Anxiety

Anxiety is a feeling of panic or apprehension, which is often accompanied by physical symptoms such as sweating, rapid heartbeat, agitation, nervousness, headaches and panic attacks. Anxiety may accompany depression or be seen as a disorder by itself. It is often caused by circumstances that result in fear, uncertainty or insecurity.

People with HIV sometimes experience post-traumatic stress disorder. This occurs when a person has experienced a traumatic event that the memory is unable to process properly. This can cause flashbacks, nightmares, and nervousness.

If the anxiety is caused by practical problems, then practical help to address the difficulties may well provide a solution. Counselling may also be helpful, and a short course of cognitive behaviour therapy with a psychologist can help develop the skills to understand the origins of the anxiety and to control it.

Anxiety, which occurs alongside depression, is often successfully treated by antidepressants. And massage, acupuncture, other complementary therapies and exercise can all relieve the symptoms.

Drugs such as benzodiazepines, including Valium, 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.

Metal health problems as a side effect of anti-HIV treatment

The anti-HIV drug efavirenz (Sustiva) can cause psychological disturbances. Some people have difficulty sleeping, or vivid dreams or nightmares. Other people have reported depression without any other apparent cause. If you are taking efavirenz and experience these problems it may be possible to switch to another drug that does not cause these side effects.

Looking after your mental health

There are many things you can do to look after your own mental health. Here are some suggestions:

Make sure you get enough to eat, and try and take pleasure from food
Ensuring you get enough sleep is important for both your mental and physical health
Take some exercise that you enjoy
Restrict your intake of alcohol and use of recreational drugs
Deal with work, relationship, money or housing problems as soon as possible
Allow yourself some pleasures in life
Don’t hate yourself for being who you are
Don’t judge yourself harshly
Set yourself achievable goals or standards and reward yourself if you achieve them. Don’t punish yourself if you don’t
Don’t bottle up worries or concerns, talk to somebody about them
Don’t isolate yourself, join in with activities
Try something new

Finally, if you are finding things too much, ask for help – there will be somebody who can help you.

Last updated April 2010