The Positive Side

Winter 2008 

Ask the Experts: Dark Days

The short days, the grey skies, the gusting winds — it all makes me feel dreary, like the weather has moved into my head. I often get a case of the blues this time of year, but I can’t tell whether this is normal or something more serious. What are the signs of genuine depression and what can I do to make it through?
— C.B., Vancouver

DR. JULIE MAGGI

Psychiatrist
St. Michael’s Hospital and Women’s College Hospital
Toronto

The symptoms of depression are when someone feels — for at least two weeks — that their mood is low, or they feel that they’re losing interest in things they enjoy doing. This is accompanied by a combination of the following: a change in appetite, problems sleeping, low energy, feeling slowed down, difficulty concentrating, feeling worthless, and maybe thoughts of suicide or that life is not worth living.

We know from studies that people with HIV are at higher risk of developing depression. Biological factors, such as the effects of a chronic illness, may be one reason for this increased risk. Living with HIV can also present certain stresses, including coping with stigma and coping with a chronic illness. As well, some anti-HIV medications can cause side effects such as depression.

The first thing I do when I suspect someone is depressed is to learn as much as I can about the person and their symptoms of depression: How long has the person had symptoms? Are there any stressful events that triggered them? If there’s a history of depression, how was it treated? Are there any medical causes for their symptoms? Is there a family history of depression? What supports does the person have in place to help them cope? I then try to create, with the person, an individualized treatment plan, usually a combination of therapy and medication.

After I make a diagnosis of depression, I may start someone’s treatment with one of the SSRIs (selective serotonin reuptake inhibitors, such as Paxil, Zoloft and Celexa), primarily because they may be better tolerated than some older medications. Cognitive-behavioural therapy (generally speaking, learning to understand the connection between your feelings, thoughts and actions) and interpersonal therapy (helping someone work through grief, transitions, relationship disputes) are short-term treatments for depression. One or the other might be the best fit for someone dealing with depression.

People can talk with their family doctor, who can assist in diagnosis, treatment planning and referral to a psychiatrist if necessary. AIDS service organizations can be helpful when looking for resources in the community. Many SSRIs are covered by extended health plans and provincial formularies, but it’s best to check with your pharmacist for the details in your province or territory.

 

JOHN MONTAGUE MSW M.Div RSW

Individual, Couple and Family Therapist
Toronto

Talk therapy, or “therapeutic conversation,” is telling your story and feeling that your voice is being heard. People know quickly if their therapist seems to understand their emotional pain. Empathy is either there or it’s lacking.

When helping people who are depressed, I am first interested in hearing about when they began feeling depressed, and I ask them to describe what it was like before that in order to get a baseline for how they see their normal functioning.

I help people understand that they are not the problem — the problem is the problem. I help them to take control back from depression by externalizing it and seeing it as separate from themselves. This can involve not accepting the identity that others put on them, which may be making them feel down. By objectifying the problem, clients can begin to form their own sense of self that is separate from the expectations that others, including society in general, have placed on them. It is easier to question and address the depression once it is separated.

I remind people that they are the experts on themselves, and rather than give advice I try to offer questions for people to ponder. For example: What is depression telling you about yourself that is not true? What is depression stealing from you? Do you talk back to depression and what do you tell it? I would also ask people about their support networks and who in their life is helpful. Are there people who are not helpful, and, if so, how can they be handled differently? I would ask about their exercise habits and talk about the need to take power back from depression by being more active rather than passive.

Unlike anti-depressant medication, talk therapy helps people reflect on how they can be an active participant in their healing and not let depression take power away from them. This can involve journaling or any form of artistic expression that is life-giving. Above all, people living with HIV who start to address their depression often embrace new goals that become important to making constructive changes in their lives.

 

DR. TASLEEM KASSAM

Naturopathic Doctor, Clinic Director
Effective Health Solutions
Calgary

I diagnose depression using the Hamilton Depression Scale, which rates appetite, sleep, motivation and more. Based on that I develop a plan. In naturopathy, we do very individualized care. I see it as I’m treating a person who happens to be depressed.

I personally favour a more homeopathic approach because a) I’ve seen it work, b) it’s not tedious to take the therapy (with nutritional supplements it sometimes can be) and c) there’s no interaction with the range of pharmaceuticals someone can be on, as there can be with some supplements. People with HIV should know that St. John’s wort, a supplement often taken to counter depression, can interact with many anti-HIV drugs, so tell your doctor if you are on meds and are taking St. John’s wort or thinking of doing so.

The idea behind homeopathy, put succinctly, is that small doses of certain herbs or minerals exaggerate symptoms and force the body’s defence mechanisms to kick in. The body’s defences, sometimes called PNEI [psycho- neuro- endocrine immunology], are affected by homeopathic treatments and respond to them by trying to come back to equilibrium.

I’ll check the person’s hormone balance and also make sure he or she is getting enough of the right nutrients: vitamin B6, melatonin, vitamin D3, vitamin B12, folate and omega-3s. Because of the virus, people with HIV can sometimes have mineral or vitamin deficiencies and not know it. It’s amazing how tweaking some of those small things can help.

In the end, the goal is to get to a place of balance where you’re not dependent on any substance.

For more information about homeopathy and other complementary therapies, check out CATIE’s Practical Guide to Complementary Therapies and Practical Guide to Herbal Therapies.

 

BLAIR PELLETIER

Cultural Mentor
All Nations Hope AIDS Network
Regina

In the programs we run, we have one-on-one counselling and we also have wellness circles. We had a wellness circle just for people who have HIV and we’ll be starting one up again soon.

The wellness circle is traditional. You sit in a circle and talk about the things that are bothering you, and I think the importance of it is that everybody is on the same page and they support each other. It’s nice to sit in a circle and realize “I’m not the only one who’s facing this.” People tell their stories. They cry sometimes. It gives them an opportunity to get rid of some of that garbage they’re carrying around, a place to vent some of the stored-up emotions. Other times we just sit around and drink coffee.

We have ceremonies we go to. There’s a sacred area that’s just on the outskirts of Regina, and we have a sweat lodge there. I do sweat lodge ceremonies. I bring people out there and it’s really beneficial for them. Whether you’re HIV positive or not, it helps to get back to our traditional way of life.

I think the element that’s often missing in anything that Aboriginal people face is spirituality. We’re a spiritual people, and if you look at anything that’s wrong in our lives and struggles that we go through as a people, as a nation, spirituality is one of the things that’s missing. I think that once you restore spirituality you’re on the road to restoration of your identity. Anything culturally based or traditionally based has a spiritual essence; it has meaning to it. Without spirit, you’re basically going through the motions.

For more information about dealing with depression, read “Lady Sings the Blues” in the Spring/Summer 2003 issue of The Positive Side.

Illustration: Bodhi Hill/iStockphoto.com