Answered by:
Stuart D. Federman, PharmD, AAHIVP
Gateway Apothecary
Saint Louis, MO


Depression is a very serious problem with patients who have chronic diseases, including HIV. Not only can it cause isolation and other psychosocial issues; it is one of the most common reasons why patients do not adhere to their medication regimens. It may be beneficial to talk to a counselor or psychiatrist who specializes in depression to make sure that they are able to treat the underlining cause of the depression.

There are many very good medications that have minimal side effects, which providers can use to treat depression. The most commonly used antidepressants are from the serotonin uptake inhibitor class (SSRI), including Lexapro (escitalopram), Zoloft (sertraline), Celexa (citalopram) and Prozac (fluoxetine). Patients should not use St. John’s wort for depression without first talking to their pharmacist or physician.

There are many ways that people can increase their mood without taking medications. Exercise causes increased endorphins that can release neurochemicals, which can cause people to have better moods. Patients also can go outside to get sunlight. Florescent lights can cause a depressed mood.

Certain antiretrovirals can cause some depressive or other symptoms. The most likely culprits include efavirenz, which is in both Sustiva and Atripla, and rilpivirine, which is in both Edurant and Complera. Also, the provider needs to remember that if the patient is taking a boosting agent, such as Norvir (ritonavir) or cobisistat, which is in Stribild, these can cause increased doses of certain antidepressants or other medication that use a similar metabolic (drug break down) pathway in the body. Check with your specialized pharmacist or medical provider to ask specific questions about depression or interactions between antiretrovirals and antidepressants.

Additional writing by Amanda Wong, student pharmacist at the St. Louis College of Pharmacy.