Depression remains one of the most common sequela of being HIV-positive.

In the past fifteen years, medical science has learned a great deal about depression as an illness and has developed highly effective

treatments. Although the brain chemistry of depression is not fully understood, it does appear that people who are depressed have an imbalance of the brain's neurotransmitters;

these are chemicals that allow nerve cells to communicate. One of these neurotransmitters

is serotonin.

An imbalance in serotonin may be an important factor in the development and severity of depression. When this imbalance is corrected, depressive feelings can be relieved. This is very good news indeed, since being depressed can be debilitating and can severely affect a person's quality of life.

However, the bad news is that most people, including healthcare clinicians, do not recognize themselves as depressed and therefore do not seek help. Also, many people still associate being clinically depressed with a form of "social weakness." Many folks feel they should just be "strong enough to get over it."

This, of course, is incorrect. Looking at a similar chemical imbalance in the body may be helpful. When a person develops diabetes, there is an imbalance of the hormone insulin and the person can no longer adequately metabolize certain sugars. This imbalance may require medication to help regulate insulin production. People simply cannot will their bodies to make more insulin and thereby "fix" their diabetes.

The same is true for depression. Many people with clinical depression cannot simply command their brains to make more serotonin. If someone breaks their arm, they seek medical attention. Very few people think a broken bone will just "go away." However, people with the signs and symptoms of depression often suffer in silence, and hope that they will feel better someday. (See the Depression Screening Sidebar).

More good news is that there are highly effective treatments for depression. There is a  class of medications that have helped millions of people. The selective serotonin reuptake inhibitors or SSRIs help restore the brain's chemical balance by increasing the supply of serotonin without affecting many of the other chemicals in the brain that affect mood. Some examples of SSRIs are citalopram (Celexa¨, Forest); Fluoxetine (Prozac¨, Dista); fluvoxamine (Luvox¨, Solvay); paroxetine (Paxil¨, GlaxoSmithKline); and sertraline (Zoloft¨, Pfizer). These are not "happy pills." People typically do not get a high from SSRIs like they may get when a tranquilizer, such as Valium or Xanax, is taken. SSRIs generally take about two to four weeks to take effect. Many patients come back to report that they just "feel better" or that a "veil has lifted."

Other very valuable interventions include talk therapy with a competent therapist, meditation, prayer, and a large variety of relaxation exercises. There is no one answer or treatment. Many experts agree that combination therapy works best when it includes counseling along with antidepressants.

Whatever the cause, many cases of depression  are treatable. Depression in HIV disease can lead to a decreased quality of life, and poor treatment adherence.

Please see Dr. Ferri's bio on page 85.