Antidepressants for depression in adults with HIV infection


Ingrid Eshun-Wilson 1, Nandi Siegfried 2, Dickens Akena 3, Dan Stein 4, Ekwaro Obuku, 5 John Joska 4

1. Centre for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

2. Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South AfricaDepartment of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

3. Department of Psychiatry, Makerere University, College of Health Sciences, Kampala, Uganda

4. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

5. Africa Centre for Systematic Reviews & Knowledge Translation, College of Health Sciences, Makerere University, Kampala, Uganda

Eshun‐Wilson  I, Siegfried  N, Akena  DH, Stein  DJ, Obuku  EA, Joska  JA. Antidepressants for depression in adults with HIV infection. Cochrane Database of Systematic Reviews 2018, Issue 1. Art. No.: CD008525. DOI: 10.1002/14651858.CD008525.pub3

Access the full-text here: DOI: 10.1002/14651858.CD008525.pub3/full

Why is this review important?

Depression is very common among people living with HIV. There are many unique issues which influence the development and possibly the recovery from depression in this group. We are therefore uncertain whether the antidepressant drugs which are usually used to treat depression in people without HIV will be as effective in PLWH.

Who will be interested in this review?

PLWH, general practitioners, HIV clinicians and professionals working in mental health services.

What questions does this review aim to answer?

‐ Are antidepressant medicines more effective than using a placebo (pretend treatment) for treatment of depression in PLWH?

‐ Do more people stop attending services (dropout) if they are receiving antidepressant medicines compared to placebos?

‐ Are there any serious side effects to antidepressant medicines which specifically affect PLWH?

‐ Which type of antidepressant medicine is most effective for depressed PLWH?

‐ Does treating depression with antidepressants in PLWH improve antiretroviral treatment outcomes among people also receiving HIV treatment?

Which studies were included in the review?

We searched several databases to find randomized controlled trials (clinical studies where people are randomly put into one of two or more treatment groups) which compared antidepressant therapy to placebo or other antidepressant drugs for treatment of depression in PLWH. Studies had to have been conducted between 1 January 1980 and 18 April 2017 to be included in the review. Ten studies with 709 participants were included.

What does the evidence from the review tell us?

Most studies were conducted more than a decade ago, in the USA, in predominantly men. We found that antidepressant therapy may improve depressive symptoms when compared to a placebo tablet. There was no clear evidence of a difference in the number of people who dropped out of care when comparing people who received antidepressants with people who received a placebo. We cannot be certain if one type of antidepressant works better than another. Side effects were very common among all study participants. Although there were no clear conclusions on which side effects were most common or if side effects occurred more frequently in people taking antidepressants compared to a placebo, participants receiving antidepressants called selective serotonin reuptake inhibitors did report sexual problems frequently. People receiving medicines called tricyclic antidepressants reported constipation and dry mouth frequently. No studies reported on how antidepressant therapy affected the effectiveness of antiretroviral therapy. The evidence used to generate several of the results was assessed as low or very low quality.

What should happen next?

The review authors recommend that new studies on treatment of depression should be conducted in countries and population groups where HIV is most common. These studies should evaluate what causes depression in these populations and how to best to incorporate antidepressant therapy with other strategies for the management of PLWH and depression.