Prevalence, impact, and management of depression and anxiety in patients with HIV: a review

Suprakash Chaudhury,¹ Ajay Kumar Bakhla,² Rajiv Saini,<sup>3

1</sup>Department of Psychiatry, Pravara Institute of Medical Sciences (Deemed University), Loni, Maharashtra, ²Department of Psychiatry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, ³Department of Psychiatry, Armed Forces Medical College (AFMC), Pune, Maharashtra, India

Abstract: The prevalence of depression and anxiety in people living with HIV/AIDS (PLWHA) ranges from 7.2% to 71.9% and 4.5% to 82.3%, respectively. This wide variation is attributed to differences in sample size and characteristics, and methodology for assessment of anxiety and depression. Moreover, anxiety and depression increase the morbidity of HIV by poor adherence to treatment and various other significant mechanisms. Early identification and effective management of these disorders is associated with improved antiretroviral adherence and improved quality of life in PLWHA. Different treatment modalities, including pharmacological and nonpharmacological therapies, are used for the management of anxiety and depression in PLWHA. Benzodiazepines are indicated for short periods of time. Clonazepam and lorazepam are safe in terms of drug–drug interactions and may be preferred. Selective serotonin reuptake inhibitors are safer than tricyclic antidepressants. Though the different selective serotonin reuptake inhibitors are supposed to be equally effective, to avoid interactions with antiretrovirals, the better options are sertraline, citalopram, and escitalopram. Various nonpharmacological therapies, including cognitive behavior therapy, interpersonal therapy, supportive psychotherapy, cognitive–behavioral-oriented group psychotherapy, experiential group psychotherapy, cognitive–behavioral stress management, stress management interventions, cognitive remediation therapy, mindfulness-based therapy, and aerobic and resistance exercise have been reported to be useful in treating depression among PLWHA. However, definitive evidence to decide which nonpharmacological intervention is most beneficial for the management of anxiety and depression in PLWHA is still required.

Keywords: tricyclic antidepressants, benzodiazepines, SSRI, CBT, interpersonal therapy, mindfulness based therapy