Is Every Day a Rainy Day?

And even when doctors do broach the topic, some patients may not be comfortable acknowledging how they really feel. “People often fear being stigmatized or are not sure how their doctor will react,” says Horwath. “Or they may feel embarrassed or ashamed of the symptoms they have.”

That is how it was for Geof. “I had a lot of guilt and shame about it,” he says. “Everybody else seemed to be able to handle it and live a normal and productive life. And there’s such a stigma attached to antidepressant medications. I’d think to myself, Why can’t I handle this without a pill?”

Others may know something is wrong but not identify what they are experiencing as depression. “I have to teach patients about depression because depression is sometimes more subtle than people think it is,” says Michael Shernoff, MSW, a practicing psychotherapist and expert on AIDS and mental health issues. It is important to realize, he says, “that the reason you may not be able to make the changes that you want in your life is not because of some kind of character defect but that you may be suffering from a depression that can be treated.”

But although antidepressants have been lifesavers for many individuals, they are not without their own side effects—and that may be one side effect too many for people who already have myriad side effects from their anti-HIV medications. In addition, Shernoff says, “many people who are already taking a lot of antiretroviral drugs just don’t want to take another drug.”

Even people who are taking antidepressants or are in traditional talk therapy may need additional assistance in improving medication adherence, especially because these drugs alter the chemical balance in the brain. Additional problems arise because specific antidepressants and antianxiety medications affect people in different ways. And finding just the right dosage is another issue.

Until the right medications are matched to the right person—and that person’s required dosage is found—it can leave a patient who began therapy simply feeling lost now feeling he or she is even more so. Thus, other specific types of therapy may prove beneficial, and efforts are now under way to help physicians fine-tune their approach. For example, Steve Safren, Ph.D., a research scientist at Fenway Community Health Center, is looking at whether cognitive behavioral therapy, a type of therapy that focuses on helping people gain insight into how they look at events in their lives and their reactions to those events, can help people improve their treatment adherence.

Currently no evidence exists that HIV in and of itself causes depression. However, depression is known to be a side effect of certain anti-HIV medications. In fact, a majority of the 130 HIV-treating physicians who responded to the IAPAC survey said they believed their patients’ mental health symptoms could be linked to their antiretroviral drugs.