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Depression Stalks HIV Patients

But patients say doctors don't make mental health a priority

FRIDAY, Oct. 25, 2002 (HealthDayNews) -- Perhaps as many as 80 percent of people infected with the AIDS virus suffer from depression or anxiety, a new survey reports.

A companion survey of HIV-infected patients found that many suffer from other conditions like insomnia and lethargy, but most reported that their doctors never asked about their mental health.

"The AIDS treatment community has focused very much on the physical conditions related to the disease, but these various symptoms have received insufficient attention," said study author Dr. Ewald Horvath, an associate clinical professor of psychiatry at Columbia University.

Death rates from AIDS fell dramatically in the late 1990s in the United States as powerful drugs became more common. Typical AIDS patients can now expect to live for several -- perhaps many -- years if they take drugs as prescribed, although there is a growing number who are immune to one or more of the medications.

But even while their lifespans may be longer, two surveys in Horvath's study suggest that HIV-infected patients still face a variety of emotional challenges. The findings appear in the October issue of the Journal of the International Association of Physicians in AIDS Care.

Of 235 HIV-positive people surveyed, most of whom were diagnosed at least four years ago, 72 percent reported symptoms of depression. Sixty-five percent reported suffering from anxiety, and between 40 and 48 percent reported insomnia, lethargy, impaired concentration, and mood swings.

The study didn't compare the mental health of the HIV patients to other people with chronic diseases, like diabetes, or with the general population. But, Horvath said, "in terms of psychological effects it [HIV infection] probably has equal or greater effects than some other illnesses."

More than 80 percent of the 136 U.S. doctors surveyed said mental health is a top priority when they make decisions about treatment, but 62 percent of the patients said physicians never bothered to ask them about their mental state.

The problem is that the doctors treating AIDS patients are mainly in the infectious disease and internal medicine fields, Horvath said. "They're not experienced or trained in mental health or psychiatry."

While some doctors blame AIDS drugs for depression and anxiety among their patients, a California doctor who specializes in treating HIV-positive people said the medications aren't always at fault.

"Does having a chronic medical condition produce depression? Definitely. Do a lot of HIV-impacted patients have some underlying psychiatric or emotional issues? Yes," said Dr. Michael Horberg, a physician in Santa Clara, Calif.

Ultimately, he said, the mental health of AIDS patients largely depends on "whether they're ready to deal with all their issues of depression and whether they're ready to deal with all their other illnesses, including maybe some substance abuse issues."

In many cases, the most important factor is the patient's ability to deal with the challenges that come with life, said Dr. Jerrold Polansky, a psychiatrist in San Francisco. "It's as individual as the person and his or her ability to cope with a stressor such as ill health or learning of a potentially fatal condition."

What To Do

Learn more about HIV from the CDC's Divisions of HIV/AIDS Prevention and AIDS Action.

SOURCES: Ewald Horvath, M.D., associate clinical professor of psychiatry, Columbia University, New York; Michael Horberg, M.D., medical director, HIV services, and chairman, Northern California Pharmacy and Therapeutics Committee, Kaiser Permanente Health Plan, Santa Clara, Calif.; Jerrold Polansky, M.D., psychiatrist, co-chair of education, Gay & Lesbian Medical Association, San Francisco; October 2002 Journal of the International Association of Physicians in AIDS Care
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