Johnny Guaylupo was 17 years-old when he found out he had HIV. Having suffered from black moods throughout much of his young life, he quickly took a dangerous emotional turn.
"I started getting depressed about my diagnosis," he said. "What to do about telling my family, my friends. I thought my life was over."
After a dispute with the older man with whom he was in a "bad so-called relationship," he attempted suicide.
HIV tends to strike those who are already at risk for depression and other mental disorders. Add this to the strain of living with a stigmatized disease, and the fact that both HIV itself and the medications used to treat it can cause depression, it's no wonder that rates of the mood disorder end up four to five times higher in HIV-positive people than in the general population.
Psychologists caution those suffering from such intense mental distress after an HIV diagnosis from thinking that their suffering is just a natural reaction to a traumatic shift in their lives.
"I think a good analogy is mourning," said Robert H. Remien, Ph.D., who studies the psychology of HIV at Columbia University. "It's appropriate to feel sad when someone close to you dies. It's not normal to go into a state of deep depression."
David McDowell, MD, a psychiatrist in private practice in Manhattan, said that when he's counseling HIV-positive patients, "you want to make that determination: is this somebody going through the normal shock and grieving? Or are they truly depressed? If they're having these profound feelings of hopelessness, and they can't sleep and they have no energy, that needs to be treated like any other depression. And that responds well to psychotherapy or medication."
Glenn J. Treisman, MD, Phd, who is the director of the AIDS Psychiatry Service at Johns Hopkins Hospital, said the symptoms of depression fall into four main categories: a drop in mood; changes in how physically well you feel; changes in your attitude about yourself; and a loss of pleasure in everyday activities which once brought you joy, such as sex, work, hobbies or exercise.
"People say there's no enjoyment," Treisman said. "There's no yeah! or things aren't good to them, or they don't really get anything out of doing what they used to do. They can tell you what they enjoy, but they're not enjoying it."
Guaylupo said he was able to bounce back from his major depression with the help of a counselor. Now 29, he works at an adult day health care program at Housing Works, a New York City AIDS service organization, a job that he said provides him with a sense of purpose and structure he lacked as a teenager.
"I know for a fact that it's not easy," he said of coping with depression, "but it's something that's treatable, that you can work through."