Following a HIV diagnosis, most people experience symptoms of depression including sleep difficulties, increased fatigue, inability to focus, unable to experience pleasure, agitation, feeling hopeless or guilty, and suicidal thought. Depression is an expected reaction to a diagnosis of a disease that can be fatal. During the first decade of the epidemic when the median age for an AIDS diagnosis was 36 (1989, CDC), rates of depression were 3-5 times higher in people with HIV than in the general population. In 1995, the introduction of effective HIV medications turned a rapid and almost inevitable death sentence into the promise of a long-life span. Despite these advances, older adults with HIV including long-term survivors experience rates of depression 3-5 times higher than seen in people without HIV.
There are many treatment strategies available for treating depression in people living with HIV. This includes anti-depressants as well as talk therapies such as groups, one-on-one counseling, and CBT (Cognitive Behavioral Therapy). People with severe depression may need to be hospitalized in order to bring the condition under control. Depression management can include life-style changes such as reducing sources of stress, as well as increasing exercise and social engagement.
What you can do with your doctor
In addition to physical tests and examinations, your doctor and/or clinician should also be conducting an annual mental illness assessment. Depression is a well-established comorbidity of HIV in older adults. You should ask your primary care physician to ALSO screen you for depression regardless of whether you or your doctor believes you are depressed. There are multiple rapid screening tools for depression (http://hiv-age.org/2016/01/26/depression-in-the-aging-hiv-infected-population/). These include the 9 question PHQ-9 or the 20 question CES-D. A trained mental health professional, working in cooperation with your primary care physician, is best qualified to manage depression and other mental health illnesses. This is a continual process that can require providers adjust treatments to achieve optimal outcomes. A diagnosis of depression does not mean you will be depressed for the rest of your life, or that you will need to take medications or be in therapy forever. If you are being treated for depression and continue to be depressed, you should tell your doctor. If your depression is being well managed, you should ask your doctor if you might be able to stop any medications or treatments. You must your own advocate for your mental health. Depression places you at high risk for multimorbidity and increased severity of those illnesses associated with aging.
What you can do
First, you can insist on being screened for depression. You must be your own advocate. You should follow all recommended depression therapies including taking your medications. You can also take steps to assess situations that could be contributing to your depression. These might include high-stress work or volunteer environments, or relationships with friends or family members. Social withdrawal and isolation are often manifestations of depression. You must actively break the cycle of social isolation, which can worsen depression. Social engagement is important. Check your local AIDS Service Organizations and LGBTQ+ Center for activities that will allow you to socialize. You might also find social opportunities through organizations for older adults such as AARP, religious congregations, and volunteer organizations. You may benefit from a partner who can help you engage in these new lifestyle changes.