Managing HIV and Depression

Depression can lead to skipping medications among HIV positive people

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Clinical depression is a very serious problem for millions of people. Not only a challenge to manage in itself, medically serious levels of sadness are associated with other disorders.

Depressed individuals can engage in unhealthy behavior with drinking, overeating and sleep. Among the unfortunate consequences of depression are that other medical problems can become worse.

Depressed people who are tasked with managing their medical problems via medications may fail to administer these diligently.

Take your meds - or tell your doctor.

Doctors prescribe drugs of a specific dosage to be taken at regular intervals to produce the desired effects. This regimen must be closely adhered to if the patient is going to benefit from the doctor's treatment plan.

Drugs taken at erratic intervals can not only fail to produce the desired benefits, they can change the patient's physiology or mental state in hazardous ways.

Viruses hijack the genetic machinery inside human cells to make more viruses. Scientists have developed drugs to combat the particular type of virus involved in HIV, known as a "retrovirus".

Patients who carefully adhere to their treatment plans for taking antiretroviral meds often see a marked reduction in viral load, helping them stay healthier and to manage the disorder much better. 

The particular situation faced by depressed persons managing HIV medication is a real source of concern. HIV viral load can be managed with care and a closely monitored pharmacological regimen. Skipping scheduled doses can be negative for both the viral load and the patient's overall health.

A patient who takes anti-viral medications erratically is putting themselves in real danger. Viral populations can become worse and more "virulent" if the drugs are not taken consistently.

Thus, doctors have considerable interest in measuring how closely people adhere to their prescribed regimen of medications.

Kathryn A. Bottonari, Ph.D and colleagues examined 225 depressed HIV-infected US veterans who were prescribed an antidepressant drug, an antiretroviral medication or both.  The team measured how many pills per day their treatment plan required them to adhere to, compared to how many pills they missed taking for the two medications, during the previous 4 days.

Bottonari and colleagues found that adherence to/keeping up with the medication schedule for taking antidepressants predicted adherence to antiretrovirals. Perhaps those who are struggling with depression can better attend to their other health needs if they are consistent about taking antidepressants.

However, the team also found adherence to taking the antiretrovirals did not predict adherence to antidepressants.

Bottonari and colleagues review of their data leads them to state that doctors who work to get their patients to improve their regular scheduled taking of antidepressants might also help their patients to stay on their antiretroviral treatment plans.

The team considers adherence to taking antiretroviral meds "especially important" because virus load can actually increase with inconsistent antiretroviral medication use.

Doctors and caregivers should pay close attention to how depression and HIV interact in a patient. If they are managing their depression through staying with their prescribed schedule of drugs, there is reason to anticipate they will do so with the HIV meds as well.

Having both disorders at the same time is a real challenge, but doctors need the patients to be consistent with the drug schedule regardless. Family members can help by reinforcing this message.

Reviewed by: 
Review Date: 
June 17, 2012
Last Updated:
June 20, 2012