Mental Health

What is Mental Health?

“Mental health” refers to your emotional, psychological, and social well-being. It is an important part of staying healthy when living with HIV.  Your mental health affects how you think, feel, and act. It also helps determine how you handle stress, relate to others, and make choices.

Positive mental health allows you to:

• realize your full potential
• cope with the stresses of life
• work productively
• make meaningful contributions to your community

Positive mental health is important for all individuals at every stage of life, and there are some particular considerations for people living with HIV.

Why is Positive Mental Health Important for People Living with HIV?

Your mental health is just as important as your physical health. When you have positive mental health, you generally are able to:

• function better at work, at school, and in relationships.
• cope more effectively with life’s difficulties, such as the death of a loved one, ending a relationship, job stress, health issues, and family or financial problems.
• take better care of yourself physically.
• provide better care for your children or other family members.

But mental health problems can affect the way you think, feel, and behave, and can change how well you function at work and at home. If you are living with HIV, mental health problems can affect your physical health by:

• making it harder for you to take all your HIV medicines on time.
• making it harder for you to keep your health appointments or take advantage of your support network.
• interfering with your healthy behaviors, such as getting enough sleep and exercise and avoiding risk behaviors such as having unprotected sex.
• impairing your ability to cope with the stresses of daily life.

Mental health problems are very common among all Americans, not just those living with HIV. In fact, in 2012, about:

• One in five American adults experienced a diagnosable mental illness.
• Nearly one in 10 young people experienced a period of major depression.
• Four percent of American adults lived with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression.

As a person living with HIV, it is important for you to be aware that you have an increased risk for developing mood, anxiety, and cognitive disorders. These conditions are treatable. People who experience mental health problems can get better and many recover completely. You can better manage your overall health and well-being if you know how having HIV can affect your mental health and what resources are available to help you if you need it.

What causes Mental Health problems?

Mental health problems are not caused by “personal weakness.” Most are caused by a combination of family history and environmental, biological, and psychosocial factors.

Common factors include:

• a family history of mental health problems and other genetic factors.
• stressful life events or psychosocial reasons, including trauma, sexual and physical abuse, neglect, and illness.
• psychological factors such as unhealthy thinking patterns and trouble managing feelings.

In addition, some forms of stress can contribute to mental health problems for people living with HIV, including:

• having trouble getting the services you need.
• experiencing a loss of social support, resulting in isolation.
• experiencing a loss of employment or worries about whether you will be able to perform your work as you did before.
• having to tell others you are HIV-positive.
• managing your HIV medicines.
• going through changes in your physical appearance or abilities due to HIV/AIDS.
• dealing with loss, including the loss of relationships or even death.
• facing the stigma and discrimination associated with HIV/AIDS.

Starting antiretroviral therapy also can affect your mental health in different ways. Sometimes, it can relieve your anxiety because knowing that you are taking care of yourself can give you a sense of security. However, it can also increase your emotions because coping with the reality of living with HIV can be complicated. In addition, antiretroviral medications may cause a variety of symptoms, including depression, anxiety, and sleep disturbance, and may make some mental health issues worse.

The HIV virus itself also can contribute to mental health problems. Some opportunistic infections (which occur when your immune system is damaged by HIV) can affect your nervous system and lead to changes in your behavior and functioning. Other disorders, such as mild cognitive changes or more severe cognitive conditions, such as dementia, are associated with advanced HIV disease.

For these reasons, it is important to talk to your healthcare provider about your mental health. A conversation about mental health should be part of your complete medical evaluation before starting antiretroviral medications. And you should continue to discuss your mental health with your healthcare team throughout treatment.  Be open and honest with your provider about any changes in the way you are thinking, or how you are feeling about yourself and life in general. Also discuss any alcohol or substance use with your provider so that he or she can help connect you to treatment if necessary. (For more information, see our page on Substance Use.)

In addition, tell your healthcare provider about any over-the-counter or prescribed medications you may be taking, including any psychiatric medications, because some of these drugs may interact with antiretroviral medications.

How Do I Know if Something is Wrong and How Can I Find Help?

Almost everyone faces mental health challenges at some point. This is true for all individuals, not just those living with HIV. It’s normal to experience some degree of worrying or fear, particularly after you have been diagnosed with HIV, or when you are experiencing changes in your health, or adjusting to antiretroviral medications.  A support network can help you cope during these tough times. But when your mental health symptoms begin to affect your ability to cope and carry out typical functions in your life, it’s important to get help.

So how do you know when it’s time to get help? Sometimes, you can notice a change in yourself—and, sometimes, the people around you are the ones who notice. Some changes that might be significant include:

• No longer finding enjoyment in activities which usually make you happy
• Withdrawing from social interaction
• Change in memory functioning
• Sleeping too much—or being unable to sleep
• Feeling “sad” or “empty” much of the time
• Feeling guilty
• Feeling tired all the time
• Experiencing sudden and repeated attacks of fear known as “panic attacks”
• Having racing thoughts
• Loss of sexual interest
• Worrying what others are thinking about you
• Hearing voices in your head
• Feelings of wanting to hurt yourself or others
• Intense anger or rage toward others

Depression

Depression is a serious medical illness. It's more than just a feeling of being "down in the dumps" or "blue" for a few days. Depression is a disorder of the brain. There are a variety of causes, including genetic, environmental, psychological, and biochemical factors. Depression can range from mild to severe, and symptoms can include many of feelings or behaviors listed above.

HIV does not directly cause depression. But depression is one of the most common mental health conditions experienced by people living with HIV, just as it is by the general population. Only a mental health provider can accurately diagnose and treat depression. Recovery from depression takes time but treatments are effective. (Learn more about people living with HIV and depression.)

Other Mental Health Conditions

Other mental health conditions include anxiety disorders, mood disorders, and personality disorders. For a good description of specific mental health problems, visit mentalhealth.gov.

Remember: a mental health disorder may be a pre-existing condition that already was a problem for a person before they had HIV; it may be first seen after an HIV diagnosis; or it may be directly or indirectly caused by the progression of the disease.

Get Help

If you feel that something might be different or “wrong,” it’s important to tell your doctor or other healthcare provider—including your nurse, case manager, or social worker—so that he or she can help you.  Don’t be embarrassed to talk about your feelings. Your feelings are important and valid and the members of your healthcare team should be concerned about you and respect you.

If what you are describing is pattern of behavior and feelings you have experienced over time, your healthcare provider may offer treatment or a referral to a mental health services provider. Mental health providers (psychologists, therapists, psychiatrists, social workers, or nurses) can use many forms of treatment, including medications and/or “talk therapy.” For more information, see the National Institute of Mental Health’s Mental Health Topics.

Finding Treatment

One of the hardest parts of having mental health condition is that you may not feel like seeking treatment or going to your appointments once you schedule them. If you are feeling this way, consider asking a friend or family member to help you make and keep your appointments, and share these feelings with your mental health provider. When you follow through, your medical and mental health providers can help you feel better, and can improve your chances of successful HIV treatment.  Also you can call 1-800-273-TALK (8255) if you need help in a crisis or are experiencing emotional distress.

To find a mental health treatment provider, use the HIV/AIDS Prevention and Care Services Locator.

Living with HIV can sometimes be overwhelming to deal with, but do not neglect your mental health. The most important thing to remember is that you are not alone; there are support systems in place to help you, including doctors, psychiatrists, family members, friends, support groups, and other services.