People with HIV are 36 times more likely to commit suicide. With World Mental Health Day coming up next month, Glynis Homing spoke to two people who have had to deal with HIV-related depression
FOUR years ago Nu (surname withheld) almost lost the wifi to live. All that kept the unemployed 23-year-old from the Valley of 1000 Hifis going was her daughter of five.
?I was very sick, unable to breathe and covered in a rash.
The clinic told me I had this thing with the name I was too embarrassed to say. My heart was dark.? Then she remembered seeing the signs of an organisation dedicated to her condition, the Hificrest Aids Centre, and fbimd her way there, where she was admitted to the Respite Unit.
The care, food, medication and ARVs saved her body, she says, but it was their sewing project that saved her life. ?It lifted the darkness ? it showed me I could be good at something and have a future.? Today Nu?s embroidery has featured on designs by Amanda Laird Cherry, and her felt cupcakes sell out at the centre?s Woza Moya shop and many others. ?Nu used to be shy? says Sphelele, a Respite supervisor: ?Now she is a different person, out-going and motivated. She is beautiful!? Glen*, a 32-year-old Durban stores controller with HIV says, ?The thrush and other stuff rubbishing my body is one thing. The mental stuff has been worse, and affected my family and friends much more. You can?t just put a condom on your moods!? Being diagnosed HIV-positive did not surprise Glen, ?I lived it up in my 20s,? he grins ruefully. Being diagnosed with depression did: ?I?m from a ?s*iap-out-of it? family. Until February this year, my dad believed there was no worry a couple of beers and Super-Sport wouldn?t sort out. I?ve been n bit of a challenge.? ?It was in February, four months after his HIV diagnosis, that Glen tried to gas himself in his car ?I left testing late, I guess I was in deniaL.. I was scared and angry mostly at myself and I didn?t know how to ask for help.? His father found him, unconscious. Medication from a psychiatrist at the hospital where Glen was taken tided him over the worst.
?It?s been tough for us all, but with therapy I?m learning to stop blaming myself and see a future. I knew it was possible to stick around on this planet for some time with ARVs, but I couldn?t see the point of it. I only wish I?d known of the depression connection before.? It is estimated that one in three people with HIV may suffer from depression. Many with HIV and some doctors assume that signs of depression are a natural response to an HIV diagnosis. ?But depression is a separate illness and needs to be treated in its own right,? says Cassey Amoore, counselling services manager for the South Mrican Depression and Anxiety Group (Sadag). ?No one needs to suf~ fer from it with the treatments available.? Studies show clinical depression affects about one in 10 of all South Africans, and is a medical condition linked to lowered levels of the neurotransmitter serotonin. It can be a side-effect of certain medications used for HIV, but it seems HIV may help trigger it biologically too. The American Suicide Foundation reports that the human immunodeficiency virus may disrupt serotonin transmission in the brain, encouraging suicidal behaviour Depression can be worsened by psycho-social factors such as isolation and low selfesteem, says Amoore. Signs to watch for are anxiety, irritability, moodiness, restlessness, feelings of sadness, hopelessness or worthlessness, fatigue, apathy, difficulty concentrating or making decisions, sleep or eating disturbahces, and escape into drink, drugs or excessive behaviours.
Extreme or prolonged stress of any kind can depress the immune system, accelerating the onset of full-blown Aids. It can also disrupt the digestive, respiratory and circulatory systems, causing physical and emotional problems.
?It remains a highly stigmatised disease,? says Amoore.
?This can lead to other stress factors such as unemployment, homelessness, financial losses and the break-up of relationships. Stigmatisation, alienation and breakdown of social support systems contribute greatly to feelings of helplessness and depression.? Without help, it can be tempting to turn to suicide.
Especially vulnerable times to
Clinical depression can be a side-effect of certain medications used for Hl?v~ but it now seems HIV may help trigger it biologically too. Photo illustration: MINDY RICKETIS
watch for are when people learn their status (which is why this needs to he done with counselling), disclose to others, start ARVs, notice the first symptoms, have a drop in CD4 count, have a major illness, or lose a relationship or job.
But while people with HIV have no choice but to live with their ifiness, they don?t have to live with suicidal thoughts.
?Depression in people with HIV/Aids is treated like any other depression,? says Polokwane psychiatrist Dr Martha Mmatlala Mabeba. This includes various forms of psychotherapy and medication. As some antidepressants (including some herbal ones like St John?s wort) may interfere with ARVs, it?s important psychologists work with doctors when prescribing.
A nutritions diet, exercise (which releases feel-good hormones), relaxation (meditation, massage), social support and a sense of purpose (from completing a project or motivating or helping others) can all help counter depression.
It is often hard to spot depression in someone who has HIV, as many of the symptoms of depression are the same as those of the illness (loss of appetite, insomnia, talk of death). Ideally, says Amoore, all HIV patients should be screened for depression.
The Journal of Acquired Immune Deficiency Syndromes reports that this may be because depression discourages people from keeping to ARV programmes, but the worsened viral load has been found in some studies to continue even when depressed patients take their medication.
Despite controversy in this area, Amoore says, ?But the bottom line is people need to get tested and treated for both HIV and depression.? For help with depression, HIV-related or not, call Sadag on 0800 567 567 or SMS 31393, or call the Aids helpline, 0800012322.
? Durban freelance writer Glynis Horning has been awarded a 2009-2010 Rosalynn Carter Fellowship for Mental Health Journalism and is researching depression and stigma in people with HIV/Aids.
Nu was deeply depressed, but thanks to the care she received from the Hillcrest Aids Centre she is now a ?different person, out-going and motivated? ? and her embroidery and felt cupcakes are hit with customers.