More Than Just Blue

 “I think a good analogy is mourning,” he says. “It’s appropriate to feel sad when someone close to you dies. It’s not normal to go into a state of deep depression. Well, it’s the same thing about HIV. It’s normal to be bummed out, maybe feel sad, maybe feel teary. It’s not normal to have persistent symptoms of depression.”

How Do You Know?

“In psychiatry, just like in the rest of medicine, diagnosis is everything,” Treisman says. “Treatment’s pretty easy—once you know what’s wrong.”

But with HIV patients, determining the source of an apparent mental health problem can be tricky. How can you know, for example, whether to blame HIV, depression, or antiretrovirals for your weight loss or fatigue? Also, some anti-HIV medications have specific mental health side effects. And research suggests that the virus itself may cause changes in the brain that lead to depression.

Marcya Owens, a 38-year-old from Madison, Ala., whose long-term struggle with depression has left her on disability, says she spent two years in a suicidally depressed state, at some times even psychotic, after beginning Sustiva, a common cause of mental health side effects for many HIVers. After her doctor switched her to an alternative medication, she says, her mental state improved dramatically.

“Then it got to the point where it was just plain depression but functional depression,” Owens says. “I was able to function.”

Treisman says the pivotal mental health question to ask is whether HIVers have experienced a loss of pleasure in their daily life from normally pleasurable activities. Known as anhedonia, this is a classic feature among depression symptoms. If the answer is yes, then you may be able to find a successful psychiatric solution. This can include prescription antidepressants, counseling, or other forms of mental health support.

Owens says she has found better footing through not only a friendlier anti-HIV medication regimen but also a different antidepressant prescription. And while she once thought her family would be better off without her, today she lives for her family members as well as her faith.

“My family is so awesome,” she says. “Then again, so is my relationship with God. You have to have something of a higher power to get through the hard days. If you don’t have something to hang on to—whether it’s, in my case, my children—then the depression’s going to get the best of you.”

On Top of It

Naturally, many facets of living with HIV can and do cause depression. Which is all the more reason why, experts say, HIVers should be hypervigilant about developing effective coping skills.

Ken Howard, a licensed clinical social worker with a therapy practice in West Hollywood, Calif., and an 18-year survivor of HIV himself, blames what he calls “an era of profound HIV stigma” for much of the anguish in the HIVers he counsels.

“These are people who have perfect health, who are feeling well, who are looking and feeling fine,” he says, “but they’re feeling depressed because they feel like they are forever damaged goods. In some cases what they experience is not just ‘I don’t want to sleep with you because you have HIV’; it’s ‘I don’t want to know you because you have HIV.’ ”

Randal Province, a 48-year-old who lives in a suburb of Memphis with his HIV-negative wife, knows about that kind of reaction from people. On disability because of an injury, he says gastrointestinal side effects from his anti-HIV meds make him afraid to venture too far from home.

But stigma that stems from his having HIV has played a cruel hand in furthering his isolation. Afraid of how the local community would react to his serostatus, he’s told only his close family and one friend that he has HIV, and even that has proved to be too wide a circle of disclosure. A few years ago his brother, a well-educated businessman, served him Thanksgiving dinner on separate dinnerware from the rest of the family—which he then disposed of after the meal.