Document 0715
 DOCN  M9460715
 TI    HIV-related depression.
 DT    9404
 AU    Perry SW 3rd; Department of Psychiatry, Cornell University Medical
       College, New; York Hospital, NY 10021.
 SO    Res Publ Assoc Res Nerv Ment Dis. 1994;72:223-38. Unique Identifier :
       AIDSLINE MED/94159976
 AB    While there is still much to be learned about depression in the context
       of HIV illness, studies over the past decade are generally reassuring.
       True, low-grade depressive symptoms are frequent among both HIV-positive
       and at-risk HIV-negative adults, but depressive disorders are the
       exception and not the rule, occurring in about 1 of 10 individuals.
       Similar to non-HIV populations, these depressive disorders are more
       likely to occur among those HIV-infected adults with severe personality
       problems, with a history of previous depressions, and with limited
       current social support. Although rates of depression may slightly
       increase with development of more severe physical symptoms, even then
       the clinician should not consider the presence of a depressive disorder
       as understandable, justified, and therefore normal. Rather, depressive
       symptoms accompanied by suicidal ideation are signals for further
       evaluation and treatment. When antidepressant treatment is indicated,
       the weight of current evidence suggests that standard therapies can be
       safely and effectively prescribed for HIV-infected adults. For
       outpatients without severe physical illness, antidepressant medications
       are generally well tolerated in recommended dosages and do not increase
       immunosuppression. For those with more severe physical impairment, the
       adage for geriatric populations is applicable: Start low and go slow. If
       lethargy and cognitive slowing is a major component of the depression,
       especially among those in later stages of disease, then psychostimulants
       may be helpful. When concerns about drug abuse preclude such a
       prescription, an activating antidepressant may be just as helpful to
       improve both mood and energy. For severe or refractory depressions, such
       as delusional affective disorders. ECT has been safely given to
       HIV-infected patients. And finally, accumulated clinical experience and
       a couple of systematic studies suggest that psychotherapy, alone or in
       combination with antidepressant drug therapy, can be remarkably
       beneficial. In sum, data support the fact that we have much to offer our
       depressed HIV-infected patients. Our task is to make sure that we
       identify their depressions when present and counter their feelings of
       hopelessness by ensuring that effective antidepressant treatments are
       provided.
 DE    Adult  Antidepressive Agents/THERAPEUTIC USE  AIDS Dementia Complex/DRUG
       THERAPY/*PSYCHOLOGY  Depressive Disorder/DRUG THERAPY/*PSYCHOLOGY
       Female  Human  HIV Infections/DRUG THERAPY/*PSYCHOLOGY  Male  Risk
       Factors  Suicide/PREVENTION & CONTROL/PSYCHOLOGY  Support, U.S. Gov't,
       P.H.S.  JOURNAL ARTICLE  REVIEW  REVIEW, TUTORIAL

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).