Depression and HIV Patient Dr K T Tricoridis, Wits Donald Gordon Medical Centre

Case Study Mrs PS , 45 , married 3 school going children, at a clinic . Aware that she has “changed” – impatient and very irritable, very worried about everything (her family , her work). She has no energy, can’t get out of bed, can’t face the complaints at work. Body aches and has bad headaches. Sleeping very poorly. Appetite very hungry craves sweets but can’t eat a thing weight loss. Can’t face people friends, not good enough , bad mother Feels all have abandoned her, even God because all bad things are “sent “to her. Children don’t help. Husband ignores her and seems to have a wondering eye(is always late from work). Went to clinic to check why she has headaches and palpitations Even more anxious as bloated . Physical and bloods were taken.--------What bloods? Asked to come in for results-------

Depression Depression describes many things like- short dip in ones mood, various degrees of sadness and a disorder . Disorder- Specific AFFECTIVE and SOMATIC symptoms, lasting for at least 2 weeks; causing significant distress and impairment in social, occupational functioning.

Symptoms Affective- morbid preoccupation with worthlessness, constant guilt , mood is down, no interest in anything, anxiety , suicidal ideation. Somatic- weight issues, appetite, sleep problems, agitation or retardation, tiredness and poor concentration, loss of libido.

People at Risk: Genetic predisposition, other medical conditions(infection, hepatitis, vits deficiencies) malnutrition, social problems Past psychiatric history of depression, suicide attempts, anxiety, postpartum, mood disorders Substance abuse history HIV scenario- Not disclosed one’s status, have lost loved ones to HIV, treatment failures, HIV MEDICATION IMPORTANT : to screen for depression- improves the HIV treatment outcome

Lifetime Prevalence of Depression tends to be higher in patients with HIV The range tends to be 22-60 %. Illness progression does not seem to increase the rate of depression

Treatments Antidepressants SSRI- Fluoxetine, Citalopram, Sertraline Buproprion Venlefaxine Trazodone Tricyclics

Hormones ECT PSYCHOTHERAPY - CBT - -Adjustment disorders OTHER –mood stabiliser –Epilim, Lamotrigine Length treatment -8-12 months Side effects START SLOW and GO SLOW and COME OFF EVEN SLOWER

CAREFUL Drug –drug interaction Protease Inhibitors (Norvir (ritonavir) or Kaletra (lopinavir + ritonavir),. Ritonavir may increases the amount Wellbutrin and Serzone and St John’s wort Individual Sensitivity and Side effects

SUICIDE SUICIDE RISK– Previous history Family History Ideation –Planning or fantasy Males and Females Degree of hopelessness, support structures Religion