To review the safety and efficacy of selective serotonin-reuptake inhibitors (SSRIs) for the treatment of depression in adults with HIV.
DATA SOURCES:
We searched Pre-MEDLINE and MEDLINE (1966-May 2004) using terms including generic names of antidepressants and antiretrovirals, depression, HIV, and acquired immunodeficiency syndrome. All English-language articles were included in this review.
DATA SYNTHESIS:
SSRIs may be effective and better tolerated than tricyclic antidepressants in HIV-positive adults. SSRIs did not appear to affect CD4+ cell counts.
CONCLUSIONS:
Controlled trials comparing SSRIs are lacking; thus, it is difficult to determine whether one SSRI is more efficacious than another. It appears that most SSRIs may be used in HIV-positive adults. If drug-drug interactions are a concern, sertraline, citalopram, and possibly escitalopram may be considered.
Centers for Disease Control and Prevention. Cases of HIV infection and AIDS in the United States. www.cdc.gov/hiv/stats/hasr1402.htm (accessed 2004 Apr 25).
3.
CieslaJA, RobertsJE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry2001; 158: 725–30.
4.
BingEG, BurnamMA, LongshoreD, FleishmanJA, SherbourneCD, LondonAS, et al. Psychiatric disorders and drug use among human immunodeficiency virus—infected adults in the United States. Arch Gen Psychiatry2001; 58: 721–8.
5.
VitielloB, BurnamMA, BingEG, BeckmanR, ShapiroMF. Use of psychotropic medications among HIV-infected patients in the United States. Am J Psychiatry2003; 160: 547–54.
6.
PenzakSR, ReddyYS, GrimsleySR. Depression in patients with HIV infection. Am J Health Syst Pharm2000; 57: 376–86.
7.
LesermanJ, PetittoJM, PerkinsDO, FoldsJD, GoldenRN, EvansDL. Severe stress, depressive symptoms, and changes in lymphocyte subsets in human immunodeficiency virus—infected men. A 2-year follow-up study. Arch Gen Psychiatry1997; 54: 279–85.
8.
SinghN, SquierC, SivekC, WagenerM, NguyenMH, YuVL. Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: Prospective assessment with implications for enhancing compliance. AIDS Care1996; 8: 261–9.
9.
RabkinJG, WagnerGJ, RabkinR. Fluoxetine treatment for depression in patients with HIV and AIDS: A randomized, placebo-controlled trial. Am J Psychiatry1999; 156: 101–7.
10.
ZisookS, PeterkinJ, GogginKJ, SledgeP, AtkinsonJH, GrantI. Treatment of major depression in HIV-seropositive men. HIV Neurobehavioral Research Center Group. J Clin Psychiatry1998; 59: 217–24.
11.
TargEF, KarasicDH, DiefenbachPN, AndersonDA, BystritskyA, FawzyFI. Structured group therapy and fluoxetine to treat depression in HIV-positive persons. Psychosomatics1994; 35: 132–7.
12.
SchwartzJA, McDanielJS. Double-blind comparison of fluoxetine and desipramine in the treatment of depressed women with advanced HIV disease: A pilot study. Depress Anxiety1999; 9: 70–4.
13.
ElliottAJ, UldallKK, BergamK, RussoJ, ClaypooleK, Roy-ByrnePP. Randomized, placebo-controlled trial of paroxetine versus imipramine in depressed HIV-positive outpatients. Am J Psychiatry1998; 155: 367–72.
14.
CurrierMB, MolinaG, KatoM. Citalopram treatment of major depressive disorder in Hispanic HIV and AIDS patients: A prospective study. Psychosomatics2004; 45: 210–6.
15.
LevineS, AndersonD, BystritskyA, BaronD. A report of eight HIV-seropositive patients with major depression responding to fluoxetine. J Acquir Immune Defic Syndr1990; 3: 1074–7.
16.
JuddFK, MijchAM, CockramA. Fluoxetine treatment of depressed patients with HIV infection. Aust N Z J Psychiatry1995; 29: 433–6.
17.
GrassiB, GambiniO, ScaroneS. Notes on the use of fluvoxamine as treatment of depression in HIV-1-infected subjects. Pharmacopsychiatry1995; 28: 93–4.
18.
GrassiB, GambiniO, GarghentiniG, LazzarinA, ScaroneS. Efficacy of paroxetine for the treatment of depression in the context of HIV infection. Pharmacopsychiatry1997; 30: 70–1.
19.
RabkinJG, WagnerG, RabkinR. Effects of sertraline on mood and immune status in patients with major depression and HIV illness: An open trial. J Clin Psychiatry1994; 55: 433–9.
20.
FerrandoSJ, RabkinJG, de MooreGM, RabkinR. Antidepressant treatment of depression in HIV-seropositive women. J Clin Psychiatry1999; 60: 741–6.
21.
FerrandoSJ, GoldmanJD, CharnessWE. Selective serotonin reuptake inhibitor treatment of depression in symptomatic HIV infection and AIDS. Improvements in affective and somatic symptoms. Gen Hosp Psychiatry1997; 19: 89–97.
22.
RabkinJG, RabkinR, WagnerG. Effects of fluoxetine on mood and immune status in depressed patients with HIV illness. J Clin Psychiatry1994; 55: 92–7.
23.
DeSilvaKE, Le FloreDB, MarstonBJ. RimlandD. Serotonin syndrome in HIV-infected individuals receiving antiretroviral therapy and fluoxetine. AIDS2001; 15: 1281–5.
24.
WagnerGJ, MaguenS, RabkinJG. Ethnic differences in response to fluoxetine in a controlled trial with depressed HIV-positive patients. Psychiatr Serv1998; 49: 239–40.
25.
MacGillivrayS, ArrollB, HatcherS, OgstonS, ReidI, SullivanF, et al. Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: Systematic review and meta-analysis. BMJ2003; 326: 1014–9.
26.
TsengAL, FoisyMM. Significant interactions with new antiretrovirals and psychotropic drugs. Ann Pharmacother1999; 33: 461–73. DOI 10.1345/aph.18240
27.
Package insert. Prozac (fluoxetine). Indianapolis, IN: Eli Lilly and Co., August 2004.
28.
Package insert. Norvir (ritonavir). North Chicago, IL: Abbott Laboratories, October 2003.
29.
Package insert. Rescriptor (delavirdine). La Jolla, CA: Pharmacia and Upjohn Co., June 2001.
30.
OuelletD, HsuA, QianJ, LammJE, CavanaughJH, LeonardJM, et al. Effect of fluoxetine on pharmacokinetics of ritonavir. Antimicrob Agents Chemother1998; 42: 3107–12.
31.
GutierrezMM, RosenbergJ, AbramowitzW. An evaluation of the potential for pharmacokinetic interaction between escitalopram and the cytochrome P450 3A4 inhibitor ritonavir. Clin Ther2003; 25: 1200–10.
