Major Depressive Disorder and HIV-1 Infection: A Review of Treatment Trials

Major depression is a common psychiatric presentation during the course of many chronic illnesses. Although estimates of its prevalence in people with human immunodeficiency virus (HIV) infection and acquired immunedeficiency syndrome have varied widely in the literature, it has become increasingly clear that people with HIV infection experience depression or depressive symptoms frequently, and that major depression may be the most common psychiatric disorder. This report reviewed the currently reported data and clinical trials for treatment of depression or depressive symptoms in the course of HIV infection. We have reviewed both psychopharmacologic and psychotherapy trials and although blinded efficacy studies are the gold standard, because there is often a lack of data, we have included noncontrolled (open) trials for comparison. Pharmacologic medication trials show that selective serotonin reuptake inhibitors (SSRIs), although not more efficacious, may be more tolerable and have greater overall effectiveness. Furthermore, when medications are used to treat depression, it may be essential to evaluate for tolerability and potential drug interactions to increase efficacy. Psychotherapy trials have investigated a variety of treatment modalities including group, individual, and stress reduction techniques. In treatment trials, all of these modalities have been associated with a reduction in distress and depressive symptoms. With the advances in therapy for HIV infection, treatment of a major depressive episode or depressive symptoms has become increasing important because untreated depression could both compromise medication adherence and potentiate the disabling effects of the illness.