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Question:

My brother recently told me that he is HIV positive. He found out in January and his doctors told him that he won't be put on medication now and that he should try to maintain a healthy immune system by exercising and eating dark greens. My brother, however, also suffers from depression, but he is medicated. Unfortunately I don't think his medication is working and on some days he can sleep as much as 18 hours in a day. Could his depression affect his immune system and speed up the progression of the virus?

Answered by: Milton Wainberg

The question: Could his depression (treated but not very effectively) affect his immune system and speed up the progression of the virus? The answer: Part 1. The short answer is that depression can have a negative impact and treatment has a positive impact. Studies before the HIV current medications became available were not very clear about the impact of depression on HIV but did show “association between depressive disorders, distress, and stressors and the number of HIV-related symptoms.” More recently, several studies have shown some associations between depression, stress and HIV illness progression. One study found that “faster progression to AIDS was associated with more stressful life events, more depressive symptoms, and less social support.” Another determined that “depressive symptoms among women with HIV are associated with HIV disease progression (women with chronic depressive symptoms were 2 times more likely to die than women with limited or no depressive symptoms). These results highlight the importance of adequate diagnosis and treatment of depression among both men and women with HIV as UNTREATED depression, besides affecting the quality of life of any person, may contribute with HIV illness progression. Research at the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, by Dr. Judith Rabkin, has shown that antidepressants DO NOT interfere with the immune system, making it very safe to use them in people infected with HIV at any stage of their illness. Also, several non-medication treatment modalities have been helpful in treating depression in HIV-positive individuals, among them interpersonal psychotherapy. Part 2. You also state in your question that you “don't think his medication is working and some days he can sleep as much as 18 hours in a day”. Either the medication for depression is not working, as you suggest, or it could also be that your brother may require a comprehensive assessment. For example, HIV-positive men suffer from low levels of testosterone – hypogonadism – which looks like depression. Other hormonal problems, such as low thyroid secretion (hypothyroidism) also look like can manifest like depression. So, it may be necessary for your brother to be assessed properly to define if he only has depression and how to address his symptoms. Milton L. Wainberg, MD