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Depressive Disorders ‘Vastly Underdiagnosed’ in People With HIV/AIDS

April 20, 2020

Depression is “vastly underdiagnosed” in people with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), states a literature review published online in the Harvard Review of Psychiatry.

Negative health outcomes associated with depressive disorders in the population include poorer compliance with antiretroviral therapy, lower immune function, and a higher death rate.

The review provides evidence-based recommendations, gleaned from an analysis of 125 research publications, for improving the assessment and management of depressive disorders in people with HIV/AIDS, explained authors from the University of Texas Southwestern Medical Center, Dallas, and Harvard Medical School and Massachusetts General Hospital, Boston.

Although people with HIV/AIDS have a 2- to 4-fold higher risk of major depressive disorder, depressive disorders can be complex to assess because of overlapping symptoms with HIV/AIDS, including fatigue, insomnia, and poor appetite. Medications, other medical or psychiatric conditions, psychosocial factors, and even brain damage caused by HIV can contribute to depressive symptoms. However, correct diagnosis is essential for providing appropriate treatment, according to researchers.

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Depression treatment in people with HIV/AIDS should involve medication (selective serotonin reuptake inhibitors are first-choice), psychotherapy (individual or group), and proper management of HIV/AIDS and related conditions. According to the report, just 7% of patients with HIV/AIDS and major depressive disorder in one study had access to adequate depression treatment.

Even with sound assessment and treatment, management of depression in people with HIV/AIDS presents challenges. “Challenges in management include poor adherence to treatment and the risk of suicide,” researchers wrote.

Rates of suicide in the HIV/AIDS population are 8 to 10 times higher than in the general population, according to the report. HIV-related stigma and feelings of shame may play a role in poor adherence to depression treatment, researchers found.

—Jolynn Tumolo

References

Medeiros GC, Smith FA, Trivedi MH, Beach SR. Depressive disorders in HIV/AIDS: a clinically focused narrative review. Harvard Review of Psychiatry. 2020 April 3;[Epub ahead of print]. 

Depressive disorders are ‘under recognized and under treated’ in people with HIV/AIDS [press release]. Philadelphia, Pennsylvania: Wolters Kluwer Health; April 7, 2020.

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