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

Authors Chaudhury S, Bakhla AK, Saini R

Received 23 October 2015

Accepted for publication 25 February 2016

Published 5 May 2016 Volume 2016:7 Pages 15—30

DOI https://doi.org/10.2147/NBHIV.S68956

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucette Cysique

Peer reviewer comments 2

Editor who approved publication: Dr Stephen Ferrando

Suprakash Chaudhury,1 Ajay Kumar Bakhla,2 Rajiv Saini,3

1Department 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

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