Living long term with HIV can take its toll on your mental as well as physical health. Mental health includes overall emotional, psychological and social well-being. Feeling anxious and having a low mood are common, but if these feelings persist, it may be time to get help.

Many aspects of living with HIV can contribute to anxiety and depression, including fear of illness and death, loss of loved ones, survivor’s guilt, decreased self-esteem related to body changes, chronic pain, difficulty performing daily activities, isolation and stigma. HIV can directly affect the brain, as can certain opportunistic infections, and some antiretroviral medications may also play a role.

According to the National Institute of Mental Health, HIV-positive people are twice as likely to have depression as their HIV-negative peers. Studies have shown that people with HIV are also more likely to develop anxiety or posttraumatic stress disorder (PTSD), which can result from traumatic life experiences, including physical or sexual abuse.

Depression can range from mild feelings of sadness to a persistent, severe depressed mood. In addition to feeling sad, signs of clinical depression can include a loss of interest and pleasure in most activities, unusual tiredness or low energy and recurrent thoughts about death or suicide.

Anxiety can also manifest in a variety of ways, including frequent worrying, excessive fear, feeling restless or agitated, irritability, shortness of breath and a racing heartbeat. Insomnia and poor concentration are common to both depression and anxiety. Some people with HIV feel anxiety about worsening illness, which may be triggered, for example, by a detectable viral load test result.

Mental health problems can lead to worse outcomes in people with HIV and other chronic illnesss. Feelings of depression, low self-worth or hopelessness can contribute to poor adherence to treatment, resulting in HIV disease progression. In some cases, mental health issues may lead people to seek relief through excessive use of alcohol, recreational drugs or risky sexual activity. Conversely, substance use can contribute to depression, anxiety and other mental health problems.

If you are experiencing persistent depression or anxiety, consider seeking help. Start by talking with your primary health care provider about getting a psychological evaluation and treatment, if appropriate. They may refer you to a psychologist, psychiatrist or other mental health specialist. If you have thoughts about self-harm or suicide, get help immediately—for example, you could call the National Suicide Prevention Hotline at 800-273-8255.

Diagnosing mental health problems involves ruling out physical problems that could be affecting your mood. For example, a low testosterone level or an underactive thyroid gland can lead to depression, while an overactive thyroid can trigger anxiety. If you are taking an antiretroviral regimen that includes efavirenz (Sustiva, also included in the Atripla combination pill), consider switching to a medication less likely to cause side effects such as insomnia and anxiety.

Sometimes talking with a psychologist or other trained therapist may be enough to lift your mood and relieve your anxiety. Evidence-based psychotherapy approaches include cognitive-behavioral therapy and interpersonal therapy. Many people benefit from group therapy or peer support groups. Meditation, deep breathing and other relaxation techniques may help too.

A variety of different medications are used to manage depression, anxiety and other mental health conditions. These treatments can take time to start working, and they are not equally effective for everyone. But many people who do not respond to one medication will do well on another. Some of these drugs can interact with certain HIV medications, so it’s important for your providers to work together to find a safe regimen. It may take some trial and error, but in a majority of cases, these conditions can be successfully treated.

Other steps you can take to improve your mental health include exercise, eating a healthy diet, getting enough sleep and spending time with others. Maintaining connections and avoiding isolation can be a challenge, but social support can have a big positive impact on your overall well-being.