MAY 1997


Therapists Talk 
Shrink Rap 


    Michael E. Holtby, LCSW, BCD


First published in May, 1997 in Colorado's AIDS Newsletter, Resolute!

Reproduction of this article is prohibited without permission of the author.

"I'm totally exhausted all the time. I don't sleep well. I wake up during the night and have a hard time going back to sleep. I can't concentrate. I forget things that I normally would remember, and I can't seem to make a decision of what to do. I don't know what is wrong with me. My doctor says its HIV and suggested AZT."

Journal Entry 3/14/89

The forgoing quote is from the first issue of Resolute! (Winter, 1992) in an article by Chad Kenney titled "The Blues". We have known for a long time that depression is a common problem with HIV. We often think of fatigue as associated with AIDS, (Is this the beginning of the end?), but depression is just as likely to be the cause.

Clinical depression is the most common reason people come to see me for psychotherapy whether they are HIV negative or positive. According to the National Institute of Mental Health, 17 million people suffer from depression in this country each year. The incidence of depression is even higher with HIV. Life is hard enough, but obviously far more difficult when you add a stigmatized, life-threatening illness. A 1988 study reported in the American Psychologist showed depression was present in one-quarter of the entire study population - and the highest proportion of depression was among the subjects with only ARC symptoms.

Now there is even more reason for concern: a study published in the Archives of Internal Medicine (Vol. 156, Oct. 28, 1996) has found the risk of dying for depressed PWA's is 1.67 times higher than the man free of depression. The UCSF researchers studied 402 gay men and found what we've long suspected: depression accelerates disease progression. These findings were independent of how far along the subjects were: at any point in the disease progression, depression made it worse.

Some of the aggravating factors were not simply depression alone, but what a depressed outlook lead to -- behavior which in turn, compromised the subject's immune system:

Increased substance abuse.

Increased cigarette smoking.

Less medication compliance.

More risky sexual practices.

Unfortunately, it is estimated that two-thirds of those suffering with depression don't seek help. They blame themselves, or downplay their experience as just "sad" or "blue". But clinical depression is not just a bad hair day

If you experience the following symptoms for a period of more than two weeks you are likely to be clinically depressed:

Persistently sad, anxious or empty mood.

Sense of hopelessness & discouragement.

Loss of interest or pleasure in activities.

Irritability or excessive crying.

Feelings of guilt, worthlessness.

Sleep and eating disturbances.

Decreased energy and fatigue.

Thoughts of death or suicide.

Difficulty with concentration, memory or decision making.

Chronic aches and pains.

Loss of interest in other people, withdrawal.

Loss of sexual interest.

Loss of motivation, enthusiasm, and interest in life.

You don't have to have all these symptoms to qualify. The more you have the more severe is your condition.

There is a common story in the HIV community about the guy who "gives up". He quits working, withdraws from all his friends, watches T.V. all day, and waits to die. This is almost to the level of being an urban legend. The truth is less dramatic. Depression more commonly affects those who are still trying to function, but fight off fatigue. One client described it as "walking through molasses" all the time.

It is estimated that eighty to ninety percent of those who seek treatment can significantly improve - the majority within 2-3 months. Antidepressant medications can be quite helpful. They all have side effects, and often you have to endure a trial of more than one fore you find one you can tolerate. But the positive results are often dramatic.

Psychotherapy is also recommended, as the depressed person needs to objectively sort out why he feels so stuck. For the depressed person life is all grey, and he needs to rediscover technicolor.

In addition, exercise can greatly impact depression with its release of endorphins - nature's antidepressant. And nutritional supplements can help: high-potency B-complex, extra B-6 and B-12.

A naturopathic or acupuncture doctor may also be helpful. One client reported to me, he was able to cut the dose of his antidepressant in half with the use of alternative medicine. Bach flower remedies, and hypericin (extract of St. John's wort) are often recommended.


Depression Practice Specialization



Last messed with November 15, 2001

Copyright(c) 2001 Michael E. Holtby, LCSW. All rights reserved.