Antidepressants for depression in adults with HIV infection

Abstract

Trusted evidence. Informed decisions. Better health.

Depressive Symptoms and Engagement in Human Immunodeficiency Virus Care Following Antiretroviral Therapy Initiation

“…For patients with a history of mental health conditions, even if they are not currently depressed, additional supportive services such as peer navigators and transportation assistance may be important to help ensure regular HIV visit attendance. A number of interventions exist to improve depression in HIV-infected adults, including counseling and pharmacotherapy [43][44][45]. Future studies should explore how such interventions could be combined with additional supportive services to optimize engagement and HIV care outcomes.…”

Co-morbilidad neuro-psiquiátrica en infección por VIH

“…El tratamiento del TDM en personas con infección por VIH incluye el uso de terapia farmacológica y no farmacológica. Respecto a la terapia farmacológica, se ha demostrado la eficacia de los inhibidores selectivos de la recaptura de serotonina (IRSS) en los pacientes con infección por VIH y de otros antidepresivos duales, como la mirtazapina, aunque no existe evidencia clara respecto al mejor esquema para estos pacientes 57 . Entre los fármacos más estudiados está la fluoxetina; sin embargo, dado su metabolismo dependiente de citocromos p450 hepáticos y su doble interacción por medio de la inhibición de algunos citocromos, se sugiere evitar su uso en favor de otros IRS como el escitalopram o sertralina, que tienen una vía metabólica más limpia 58 .…”

Depression in the medically ill

“…Non-neurological disorders are also associated with significantly elevated rates of MDD, including cancer (lifetime prevalence of MDD of 10-20%), diabetes (6-20%), cardiovascular diseases (CVD; 15-25%), HIV (25-40%), chronic obstructive pulmonary disease (COPD; 20-30%) and autoimmune disorders (10-30%), such as irritable bowel disease (IBD), lupus, psoriasis and rheumatoid arthritis (RA) (Ali et al, 2006;Ciechanowski et al, 2000;Eshun-Wilson et al, 2018;Geng et al, 2018;Han et al, 2011;Palagini et al, 2013;Penninx, 2017;Pérez-Stable et al, 1990;Thom et al, 2019;Wang et al, 2016). In these chronic medical illnesses, MDD is also associated with poorer medical outcomes, increased health care utilization, decreased treatment adherence and poorer health-related quality of life.…”

“…Structured and semi-structured psychotherapeutic interventions (e.g. CBT, IPT) have demonstrated antidepressant effects with small to moderate effect sizes in patients with cancer (Chong Guan et al, 2016;Okuyama et al, 2017), diabetes (Baumeister et al, 2014), coronary heart disease (Richards et al, 2018), heart failure (Das et al, 2019), HIV (Eshun- Wilson et al, 2018;Van Luenen et al, 2018), epilepsy (Elger et al, 2017) and MS (Fiest et al, 2016;Sesel et al, 2018). CBT has not been shown to be efficacious in advanced disease, although meaning-based and supportive-expressive therapies have been shown to relieve depressive symptoms in this population (Li et al, 2019;Rodin et al, 2018).…”

“…Similar to psychotherapeutic interventions, antidepressants with efficacy in the general population have demonstrated efficacy in the medically ill, but with fewer supporting studies, smaller samples sizes and lower antidepressant effect sizes (Kennedy et al, 2016;Ostuzzi et al, 2018). Metaanalytic level data has demonstrated small-to-moderate antidepressant effect sizes of antidepressants for MDD in cancer (Ostuzzi et al, 2018), diabetes (Baumeister et al, 2014;Darwish et al, 2018), coronary heart disease (Ostuzzi et al, 2019), post-stroke (Robinson and Jorge, 2016;Sun et al, 2017), HIV (Eshun- Wilson et al, 2018), epilepsy (Elger et al, 2017;Maguire et al, 2014) and MS (Fiest et al, 2016). The benefits of antidepressants in heart failure and major neurocognitive disorder are unclear with mixed results (Das et al, 2019;Dudas et al, 2018).…”