Pieper Andrew A, Treisman Glenn J
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Drug Saf. 2005;28(9):753-62. doi: 10.2165/00002018-200528090-00002.
Safe and effective treatment of major depression, one of the most common comorbid conditions in individuals infected with HIV, significantly lowers morbidity and mortality from HIV disease. However, optimal treatment of both conditions is complicated by interactions between the disease processes as well as the pharmacological agents used to treat them. In patients with HIV it may be difficult to distinguish major depression from other physiological and emotional states that present with similar symptoms. Accurate diagnosis of major depression is thus complex and essential to preventing inappropriate exposure of patients to potentially harmful psychotropic medications. This review outlines important initial steps in making this diagnosis. All patients with HIV should be screened for depression by their medical providers and referred to a psychiatrist for full evaluation when necessary. The mainstay of treatment for major depression in patients with HIV disease is pharmacotherapy. Depressed patients with HIV respond to the same wide variety of antidepressant-class medications as depressed patients without HIV, including tricyclic antidepressants, paroxetine, fluoxetine and trazodone. Notably, new studies have also shown that some psychiatric medications can inhibit HIV replication. No particular antidepressant medication is superior for the treatment of depressed HIV-infected patients; however, the most important component of treatment of major depression in HIV-disease is patient adherence, which is highly influenced by antidepressant adverse effects. This review outlines adverse effects of antidepressant-class medications that are of particular concern in HIV-infected patients and describes pharmacological strategies for overcoming these potential barriers to medication adherence. This review also describes situations in which some adverse effects of antidepressant-class medications may be safely exploited to benefit depressed patients with HIV disease. Potential interactions between antidepressant-class medications and HIV medications, as well as pharmacological treatment strategies for treating the psychiatric adverse effects of HIV medications, are also discussed.
重度抑郁症是HIV感染者最常见的合并症之一，对其进行安全有效的治疗可显著降低HIV疾病的发病率和死亡率。然而，由于疾病进程以及用于治疗这些疾病的药物之间的相互作用，对这两种病症的最佳治疗变得复杂。在HIV患者中，可能难以将重度抑郁症与表现出类似症状的其他生理和情绪状态区分开来。因此，准确诊断重度抑郁症很复杂，但对于防止患者不恰当地接触潜在有害的精神药物至关重要。本综述概述了进行该诊断的重要初始步骤。所有HIV患者都应由其医疗服务提供者进行抑郁症筛查，必要时转介给精神科医生进行全面评估。HIV疾病患者重度抑郁症的主要治疗方法是药物治疗。感染HIV的抑郁症患者对与未感染HIV的抑郁症患者相同的多种抗抑郁药物类别有反应，包括三环类抗抑郁药、帕罗西汀、氟西汀和曲唑酮。值得注意的是，新研究还表明，一些精神药物可以抑制HIV复制。没有哪种特定的抗抑郁药物在治疗感染HIV的抑郁症患者方面更具优势；然而，HIV疾病中重度抑郁症治疗的最重要组成部分是患者的依从性，这在很大程度上受抗抑郁药物不良反应的影响。本综述概述了在感染HIV的患者中特别值得关注的抗抑郁药物类别不良反应，并描述了克服这些潜在药物依从性障碍的药理学策略。本综述还描述了在某些情况下，可以安全地利用抗抑郁药物类别不良反应来使感染HIV的抑郁症患者受益。还讨论了抗抑郁药物类别与HIV药物之间的潜在相互作用，以及治疗HIV药物精神不良反应的药理学治疗策略。
