Is Every Day a Rainy Day?

Some people say it is like feeling your soul fade to black. Others say it is like losing a sense of who you are. Geof, who has known he was HIV-positive since 1985, puts it this way: “It’s like being sucked down into this vortex and feeling completely without hope and totally alone.”

This is how people try to describe the psychological and emotional complexity of depression.

Depression, like HIV, carries a stigma that can generate silence and shame. Even people who can talk openly about being HIV-positive may clam up when it comes to acknowledging that they are affected by depression or its sister illnesses: insomnia and anxiety. This silence can lead people to believe they are alone in their suffering. But that’s not the case.

Almost 10% of U.S. adults experience some form of depression every year, and a disproportionate number of these adults appear to be people with HIV, according to a study conducted in the United States by the International Association of Physicians in AIDS Care. Researchers found that more than 80% of the 235 women and men with HIV surveyed said they suffered from symptoms of depression or anxiety.

“It’s not that this survey is saying that all of these people have major depression or might be in need of treatment,” says Ewald Horwath, MD, an associate clinical professor of psychiatry at the College of Physicians and Surgeons at Columbia University. But, adds Horwath, who analyzed the survey results, the fact that so many people with HIV are experiencing depression or symptoms often related to depression—like anxiety, irritability, mood swings, or an inability to concentrate—demonstrates why mental health concerns need to be addressed by doctors who treat people with HIV.

It is especially important to diagnose depression in people with HIV because of the impact the disease can have on an individual’s physical health. “Depression can lead to lapses of adherence,” explains Seth Kalichman, Ph.D., a professor of psychology at the University of Connecticut who has studied how changes in viral load affect mental health. “And these lapses of adherence can lead to an increase in viral load.” In addition, depression may keep some individuals from making or keeping the doctor appointments that could help them ward off disease progression.

Even doctors who might recognize that mental health issues are important might feel uncomfortable with the subject or unsure of how to bring it up with their patients. The IAPAC survey found that 82% of doctors said they considered mental health issues to be one of their high priorities in making treatment decisions. Yet only 38% of the men and women with HIV who were surveyed said their doctor had ever talked with them about their mental health.