Depression

If you experience most or all of these symptoms on a daily basis for several weeks you may be depressed:

• low mood
• apathy
• poor concentration
• irritability
• insomnia
• early waking or oversleeping
• inability to relax
• physical effects such as weight gain or weight loss
• tiredness and lethargy
• loss of pleasure in your usual activities
• feelings of low self-worth
• excessive guilt
• recurrent thoughts of death or suicide
• loss of sexual interest
• social isolation
• substance abuse
• experiencing aches, pains, headaches or stomach problems that do not improve with treatment.

Mental health professionals with experience in helping people living with HIV are the best people to talk to about how to tackle depression. Some areas may not have a specialised service but your HIV clinic should be able to refer you to a mental health team in your area.

Depression is often treated with counselling or psychotherapy, sometimes alongside antidepressant medication.

Counselling and psychotherapy can help you to understand the underlying issues and make longer-term changes. Cognitive behavioural therapy (CBT) is used to help you identify negative patterns of thoughts and make behaviour changes.

Side effects of antidepressant medication should be monitored carefully to ensure that your HIV treatment is not affected, but most prescribed drugs have few interactions with regular medication.

Most importantly, ask for help when you need it. Depression is becoming more treatable all the time.

And the good news is that with the right treatment and support, most people can make a full recovery.

Depression is a mental health problem and it can have a serious impact on your ability to function in everyday life.

It is estimated that one in four people will experience some kind of mental health problem during the course of a year. In the UK, anxiety and depression are the most common mental health problems.

Some people describe depression as ‘paralysing’ and it can stop them enjoying the company of their loved ones or going to work.

Depression affects both children and adults. Lesbian, gay, bisexual and trans people are at a higher risk, as they often experience bullying, discrimination, homophobia and transphobia.

If left untreated, depression can lead to self-harm and suicidal thoughts.

Although anyone can suffer from depression, it’s twice as common among people who are living with HIV. Around one in three people living with HIV have some symptoms of depression at some point in their lives.

Despite these figures, depression is not an inevitable aspect of living with HIV –​ but it could be triggered if you feel anxious or uncertain about your future.

Among people living with HIV, the occurrence of port-traumatic stress disorder (PTSD) symptoms associated with HIV diagnosis is a common problem. Some people develop this disorder after experiencing a shocking, scary or dangerous event. PTSD can lead to depression, anxiety, bad dreams (insomnia) and frightening thoughts.

People from Black African communities who are living with HIV can experience stigma and concerns about being open about their HIV status.

If you’re a refugee or asylum seeker you may also be dealing with the effects of trauma, abuse and homelessness as well as the stress of going through the immigration process.

It’s possible you could suffer from depression without realising it.

Some HIV drugs can push levels of ecstasy (E), ketamine (K), speed, GHB and crystal meth to life-threatening levels. The comedowns after using those stimulants, as well as alcohol use, can increase depression and anxiety.

Some people living with HIV may use substances for a variety of reasons:

• to socialise,
• as part of a process of harm reduction,
• to escape or to self-medicate their mental health problems.

Emotional fitness is the ability to adapt and to be able to take action under negative conditions.

Practicing emotional fitness, like physical fitness, can take time and an ongoing commitment to achieve and maintain emotional health.

Some pointers that can help your emotional health:

1. Develop supportive relationships

Getting the support you need can alleviate the severity of depression and keep it away. On your own, it can be hard to retain perspective, but being depressed makes it difficult to ask for help.

The thought of reaching out to someone can seem overwhelming. You may feel embarrassed, too drained to talk or guilty for avoiding people. It’s vital to tell yourself that this is a symptom of your depression. Asking for support and contact is not a sign of weakness and it doesn’t mean you’re a burden to others.

How to ask for help

• Turn to friends and family members who make you feel loved and cared for.
• Try to keep up with social activities even if you don’t feel like it.
• Join a support group for people with depression. Being with others who are also dealing with it can go a long way to reduce your sense of isolation.

2. Move your body

Exercise is a powerful tool for dealing with depression. It can increase your energy levels and decrease feelings of fatigue.

Evidence suggests that physical activity triggers new cell growth in the brain, increases mood-enhancing neurotransmitters and endorphins, reduces stress and relieves muscle tension. All of these effects are vital to fighting and recovering from depression, so that it’s less likely to return.

Short, 10-minute bursts of activity can have a positive effect on your mood. Even very small activities that get your arms and legs moving can add up over the course of a day.

Try incorporating walking, running, swimming, yoga, dancing or another exercise you're comfortable with into your day. Pick an activity you enjoy – you’ll be more likely to stick with it.

3. Challenge negative thoughts

Depression can put a negative spin on everything: the way you see yourself, situations you come across and your hopes for the future.

It's difficult to change a negative way of thinking. ‘Just think positive thoughts’ can be a very irritating piece of advice that often results in feelings of failure and causes further negative thinking.

Replacing negative thoughts with more balanced ones is a skill that requires discipline. Counselling and mindfulness are perfect places to start learning these skills and practising with support.

If you don’t have access to these resources, here are some ways to begin:

• Cultivate self-compassion. Ask yourself whether you would say the things you think about yourself to someone else in your position. If not, stop being so hard on yourself. What would you say to a friend in your situation? Think about less harsh statements that offer more gentle and understanding descriptions.
• Allow yourself to be less than perfect. Many depressed people are constantly chasing impossibly high expectations – they are perfectionists. Holding yourself to unbelievably high standards all the time is exhausting and takes a toll. Beating yourself up when you fail to meet your standards puts your whole nervous system under stress.
• Begin thinking about balance – not perfection – as a goal. Do you relax enough? Do you spend time with people who you enjoy being with? Are you spending time in nature? Is there time in your day for some exercise? Is your job taking up too much of your thoughts or time? Is there anything you could do about this? Do you enjoy your job and working environment? Are you putting off making improvements to your life because you’re ‘too busy’? Perhaps it’s time to challenge that.

4. Do things that you enjoy

One way to help overcome depression is to make sure you do things that both relax and energise you.

This includes following a healthy lifestyle, learning how to better manage stress, setting limits on what you’re able to do, adopting healthy habits and scheduling fun activities into your day.

Aim for eight hours of sleep. Depression typically involves sleep problems. Whether you’re sleeping too little or too much, your mood suffers. Get on a better sleep schedule by learning healthy sleep habits.

Take a short walk outdoors even if the weather isn’t great. If there is some sunshine, have your tea or coffee outside, people-watch on a bench or sit out in the park. Aim for at least 15 minutes of sunlight a day to boost your mood. Even if it’s overcast you can still get some sunlight.

Practise relaxation techniques. A daily relaxation practice can help relieve symptoms of depression, reduce stress and boost feelings of joy and wellbeing. Try yoga, deep breathing, progressive muscle relaxation or meditation.