Are you feeling depressed from time to time? The feelings are familiar -- you don't feel like going out, you obsess over everything large and small, you feel anxious all of the time and can't figure out why. If these emotions persist for several weeks or longer, you may have clinical depression.
Depression and anxiety appear to affect gay men at a higher rate than in the general population. It's also a common condition among HIVers.
But are you truly depressed or just feeling a natural sadness that's a natural response to negative events in your life? Here's a primer on the condition -- 'Depression 101,' so to speak -- and tips on what you should do if you believe you're experiencing symptoms of low-grade or major depression.
Chemistry of Depression
Serotonin and norepinephrine are chemicals called neurotransmitters that move between nerve cells called synapses in the brain. The longer these molecules dance between the synapses in your brain the better you feel. One class of drugs used to treat depression is selective serotonin reuptake inhibitors (SSRIs). They work by keeping serotonin flowing between your synapses. Exercise, sex, and connecting with friends and family create this 'high' naturally.
Causes of Depression
Depression can have many causes. Many experts believe depression to be interplay between genetics, personality, and environment, particularly a stressful environment. A traumatic event -- the death of a family member, severe illness, or long-term stress -- can cause depression. Such depression can be temporary or lead to more severe depression. The stress associated with being gay, such as coming to terms with your homosexuality and dealing with the stigma of being lesbian, gay, bisexual or transgender, can contribute to depression. This is especially the case in circumstances where people lack social support and acceptance -- if, for example, they come from a culture or community that is strongly homophobic. Party-drug use also can cause depression by throwing your brain chemistry out of whack. A weekend of using crystal or ecstasy can deplete your neurotransmitter reserves, leaving you depressed for several days, sometimes even weeks. Chronic and frequent use of these drugs may permanently damage neurotransmitter receptors in the brain, leading to long-term depression.
Sadness Versus Depression
It's natural for everyone to feel sad from time to time in his or her life. But if you are feeling very sad and down for two weeks or more and are a lot less interested in pleasurable activities, such as going out, exercising, having sex, and connecting with other people, you may be showing symptoms of major depression. If you've been feeling low for a period of two or more years -- but not blue enough that you've lost interest in going out or having a good time -- then you are likely experiencing low-grade depression, known in clinical speak as dysthymic disorder. Besides feeling low, if you are experiencing increased anxiety or panic attacks, you may also have depression. Chronic fatigue, sleep disturbance, or chronic pain may also be masking an underlying depression.
Depression and HIV Risk
Minor depression may expose gay men to higher levels of unsafe sex and HIV risk, as these men may try to cope with low-grade depression by taking sexual risks. Researchers in Australia found that gay men who suffered mild to moderate depression were more likely than men who did not report depression to put themselves at greater risk for getting HIV by having more episodes of sex without condoms. Interestingly, men who reported major depression were less likely to report having unprotected anal sex. If you are having risky sex and can't seem to get this tendency under control, you may be suffering from low-grade depression.
Should I Talk With My Doctor?
Absolutely! Some physicians will prescribe antidepressants without referring you to a mental health professional to be evaluated. Try to avoid that if possible. Only about half of patients presenting with depression are appropriately diagnosed, and only 20% are treated correctly. While you probably trust your primary-care doctor, treating depression is probably not his or her specialty. If your provider does prescribe you antidepressant medications be certain to follow up with a psychiatrist or psychopharmacologist who is an MD or Ph.D. specializing in treating depression
Urbina is an HIV specialist and the medical director of HIV education and training at St. Vincent's Comprehensive HIV Center as well as an associate professor of medicine and an associate professor of clinical public health at New York Medical College.
