Anxiety and depression

Problems and possible causes

The diagnosis of HIV infection or AIDS is a crisis for the infected person, their family and their friends. When people receive the news of AIDS they begin to experience the psychological reactions described in Chapter Three, starting with shock. They may feel confused and that their mind is in constant turmoil. How someone reacts and behaves after this initial shock depends on many things, for example how they have dealt with stresses in their life before and what types of support they can get for emotional and social problems. Resources that are available within a culture should be used to deal with anxiety and depression.

Anxiety (a feeling of nervousness, fear and dread) and depression (a feeling of sadness and hopelessness) are normal if someone has been told that they have HIV infection or AIDS, and is trying to cope with it. It is when these feelings are very intense or last a long time, so that normal daily activities are interrupted, that they are considered abnormal.

The physical symptoms experienced with either anxiety or depression can be dramatic and may lead people to think that they are physically ill. Learning to recognize their own symptoms allows people to distinguish between those which are caused by anxiety or depression and those that may indicate the onset of an infection or illness.

Possible explanations for symptoms which resemble those of either anxiety or depression include:

· infections
· side-effects of some medicines
· malnutrition.

Anxiety

Figure

Anxiety, the feeling of nervousness, can have both physical and mental symptoms, including:

· lack of appetite
· feeling short of breath
· shaking
· a sensation that the heart is pounding
· sweating
· tingling sensations, for example in the hands
· feeling faint
· difficulty in sleeping
· a feeling of being out of control
· difficulty in concentrating
· feeling very worried
· feeling jumpy.

Other symptoms include headache, which is discussed in the section on pain.

Depression

Figure

When someone has HIV infection or AIDS they experience many losses in a very short period of time. Examples of this might include loss of health, loss of physical beauty, loss of job or ability to function in the community, loss of mobility, loss of eyesight. For all these losses a person must grieve and will at times feel very unhappy. A person may experience depression in the following ways:

· a feeling of hopelessness
· feeling tired and generally without energy
· inability to find pleasure and the sense that everything is a chore
· irritability
· inability to concentrate and poor memory
· waking up early in the morning or having trouble getting to sleep at night
· eating too much or being unable to eat.

Everyone gets depressed from time to time. Certainly if someone is facing AIDS it is likely they will be depressed for hours or even days at a time. Periods of depression may come and go, alternating with periods when the person doesn't feel depressed at all.

Depression can be more than a passing mood and is something to be concerned about if it occurs very frequently or is very intense. This sort of depression can make it difficult to deal with everyday life, and ultimately can lead people to harm themselves or to consider suicide, especially those who are isolated and those who have suffered considerable losses and stress.

What to do at home

Treatment of anxiety and depression varies from culture to culture. In many communities, support for such problems is often provided by trusted elders in the family and through traditional systems. Together with the suggestions made below, as a health care worker you should help people with AIDS to find the best support in the community.

Chapters Three and Four provide information on emotional support including psychological support and care of the dying. This information will also help you to provide care for anxiety and depression.

The process discussed in the section on psychological reactions to AIDS in Chapter Three is very important here. You can give people an opportunity to progress through the stages of grief simply by encouraging them to talk, and then by listening to them. It is not expected that you will have answers; it is enough that you are there. Encourage them to express their thoughts and feelings.

If you are aware of others in the community with AIDS or with any other chronic or terminal illness who have adjusted to their life and are willing to speak about it, consider finding ways for them to be in contact with those who are anxious or depressed. This peer contact can be a great support and inspiration.

The support you can give people with AIDS will also depend on the resources that the family and the community have to address major concerns such as child care, finances and transport. Become familiar with any support groups in your community or region which can provide help to people with AIDS and those who care for them. If no such groups are available, start one!

Help sick people plan activities on a daily or weekly basis. This can help them to fight the sense that their life is out of control or that they cannot accomplish anything. The important point here is that these plans should be realistic in terms of the person's abilities and time.

Encourage sick people and their family members to learn how to relax. This is a skill that takes time to master, but it can be very helpful. It is good to have both physical and mental relaxing activities.

Although alcohol and other "drugs" may seem to help people relax, if used in excess they may actually result in a worsening of the anxiety and depression over time.

The use of medicines for treating the symptoms of anxiety can be very helpful and may make an enormous difference to someone's ability to function. However, such medicines can have serious side-effects so their use should be carefully supervised.

When sick people and their families must seek help

· If the family or the patient believe that the anxiety or depression is severe enough that the patient may commit suicide, otherwise harm themselves, or harm someone else.

· If there is a prolonged disruption in the sick person's ability to function, such as in sleeping, eating, relating to their family or friends, or going about their daily life, that is not explained by any physical disability they may have.

Notes on anxiety and depression
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