Antidepressant Treatment of Depression in HIVSeropositive Women

Abstract

Background: This study aimed to assess the effectiveness of fluoxetine and sertraline in treating depressed women who are seropositive for the human immunodeficiency virus (HIV) and to document barriers to study participation.Method: Ambulatory HIV-seropositive women with DSM-IV depressive disorders were enrolled in an 8-week, open trial of fluoxetine (N = 21) or sertraline (N = 9) initiated at standard dosages. Outcome measures included the Clinical Global Impressions-Improvement scale (CGI), Hamilton Rating Scale for Depression (HAM-D), Beck Depression Inventory (BDI), physical function ratings, and CD4 count.Results: Thirty-six women were screened for the study and 30 were enrolled. Mean age was 35.5 years and HIV risk was primarily intravenous drug use (N = 16; 53%) or heterosexual contact (N = 12; 40%). Sixteen (53%) were Hispanic, 11 (37%) were African American, and 3 (10%) were white. Mean ± SD CD4 count was 463 ± 312 cells/µL, and 30% had acquired immunodeficiency syndrome (AIDS). Eighteen women (60%) completed the trial (14 fluoxetine: dose range, 10-40 mg/day; 4 sertraline: dose range, 25-100 mg/day). Of completers, 14 (78%) were clinical responders by CGI and reduction in HAM-D > 50%. Statistically significant reductions were seen in HAM-D and BDI scores, but not in measures of physical function or CD4 count. The most frequent adverse effects were anxiety, overstimulation, and insomnia. Reasons for nonparticipation or dropout included refusal to accept antidepressants on account of negative bias, preferring psychotherapy alone, adverse effects, and relapse to illicit drugs.Conclusion: While HIV-seropositive women may benefit from antidepressant treatment, multiple barriers to successful treatment exist. Aggressive outreach, education, and attention to the complex psychosocial needs of HIV-seropositive women are essential components of depression treatment in this population.( J Clin Psychiatry 1999;60:741-746)

HIV and depression: 2008 review and update

“…The rationale is that it is diffi cult to evaluate the effect of a study medication on mood if the patient is independently using a mood-altering substance at the same time. Also, the majority of participants in most studies have been male, although a few small studies targeted women [59]. Bangsberg et al [60] tackled a particularly diffi cult population, evaluating directly observed therapy (DOT) with long-acting fl uoxetine compared with referral to psychiatric care in a sample of homeless or marginally housed HIV+ adults, including active substance users, in San Francisco.…”

Depression and HIV/AIDS

“…Several open-label studies have shown support for the efficacy of paroxetine [32,33] and sertraline [34]. In one of the few studies comparing the efficacies of SSRIs in HIV-positive individuals, Ferrando and colleagues [33] compared paroxetine, sertraline, and fluoxetine in 33 symptomatic HIV-positive patients.…”

“…Response rates were 53% for the fluoxetine group and 75% for the desipramine group. Ferrando et al [34] compared fluoxetine with sertraline in a group of HIV-positive women, with response rates of 78% for fluoxetine and 75% for sertraline. These studies suggest that SSRIs are effective in reducing depressive symptoms in HIV-seropositive women.…”

Diagnosticando e tratando depressão no paciente com doença clínica

“…Estudos controlados mostraram a eficácia antidepressiva também em pacientes com as seguintes doenças: 1) AVE -com a nortriptilina e o citalopram. A fluoxetina teve resultados controversos nesse grupo (Andersen et al, 1994;Gonzalez-Torrecillas et al, 1995;Wiart et al, 2000;Robinson, 2003); 2) diabetes mellitus -com a nortriptilina (embora tenha sido hiperglicemiante nos diabéticos não-deprimidos) (Lustman et al, 1997) e a fluoxetina (Lustman et al, 2000), a melhora do nível glicêmico também ajudou a reduzir os sintomas depressivos em diabéticos (Lustman, Clouse, 2005); 3) no câncer -com desipramina, fluoxetina, paroxetina e amitriptilina (Holland et al, 1998;Pezzella et al, 2001); 4) AIDS -com a fluoxetina e a sertralina (Ferrando et al, 1999;Rabkin et al, 1999); 5) doença de Alzheimer -com a fluoxetina e a sertralina (Petracca et al, 2001;Lyketsos et al, 2003).…”