ABSTRACT
Neuropsychiatric disorders and syndromes may be underdiagnosed and inadequately treated in individuals infected with HIV. Depression in particular is among the most prevalent diagnoses, and data from controlled clinical studies have shown that antidepressant medications are efficacious and safe for treating depression in HIV-infected persons. A significant shortcoming of this literature is that most of the available data are from studies conducted before the advent of highly active antiretroviral therapy. In addition, apart from antidepressant medications, controlled studies systematically assessing efficacy and safety issues for other classes of psychotropic drugs (e.g., antipsychotic and anxiolytic medications) in HIV-infected persons are lacking. This review summarizes essential findings pertaining to the use of psychotropic medications to treat depression and other neuropsychiatric disorders in the context of HIV. It includes a discussion of clinically relevant treatment considerations (e.g., side effects, drug-drug interactions) derived from the existing literature as well as judgments that clinicians face in the absence of research data. Despite some shortcomings of the existing literature, overall there is compelling evidence that the appropriate use of psychotropic medications (coupled with behavioral therapy) can improve the quality of life of mentally ill HIV-infected individuals.
Subject(s)
AIDS Dementia Complex/drug therapy , Anxiety Disorders/drug therapy , Depressive Disorder/drug therapy , HIV Infections/drug therapy , HIV Infections/psychology , Psychotropic Drugs/therapeutic use , AIDS Dementia Complex/psychology , Anti-Anxiety Agents/adverse effects , Anti-Anxiety Agents/therapeutic use , Antidepressive Agents/adverse effects , Antidepressive Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Anxiety Disorders/psychology , Depressive Disorder/psychology , Drug Interactions , Humans , Psychotropic Drugs/adverse effects , Randomized Controlled Trials as TopicABSTRACT
Human immunodeficiency virus seropositive (HIV+) individuals are at a heightened risk of developing mood disorders and related syndromes. Over the past several decades, increased rates of mood disorders, including depression and mania, have been reported among HIV+ individuals. Because alterations in mood may impact on quality of life and perhaps reduce adherence to antiretroviral treatment regimens that are critical for preventing disease progression, recognition and effective treatment of mood disorders is essential. There are accumulating data showing that antidepressants and mood stabilizers, as well as other novel agents, might benefit HIV+ individuals suffering from a concomitant mood disturbance. This review highlights the relevant studies that have examined prevalence rates of mood disorders in HIV+ individuals, characteristics of HIV disease that influence the diagnosis and psychopharmacologic treatment of mood disorders, including complex interactions with antiretroviral medications, as well as the available evidence regarding the efficacy of agents used to treat depression and mania in the context of HIV disease.
Subject(s)
HIV Infections/complications , Antidepressive Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Bipolar Disorder/diagnosis , Bipolar Disorder/drug therapy , Central Nervous System Stimulants/therapeutic use , Depressive Disorder/diagnosis , Depressive Disorder/drug therapy , Hormones/therapeutic use , Humans , Mood Disorders/diagnosis , Mood Disorders/drug therapy , Mood Disorders/epidemiology , Mood Disorders/etiology , Prevalence , United States/epidemiologyABSTRACT
How can neuropsychiatric disorders and syndromes be underdiagnosed and inadequately treated in individuals infected with human immunodeficiency virus? Depression in particular is among the most prevalent diagnoses and there is a solid foundation of data from controlled clinical studies that has begun to examine the efficacy of various antidepressants in HIV-infected persons. This article summarizes essential findings pertaining to the use of psychotropic medications to treat depression and other neuropsychiatric disorders in the context of immunodeficiency. This includes discussion of clinically significant treatment considerations (eg, efficacy, side effects, drug-drug interactions) derived from the existing literature. Taken together, there is compelling evidence that psychopharmacologic intervention can improve the quality of life of mentally ill HIV-infected individuals.
