Benefits of Adherence to Psychotropic Medications on Depressive Symptoms and Antiretroviral Medication Adherence Among Men and Women Living with HIV/AIDS



Psychotropic medications are commonly used for depressive symptoms among people living with HIV/AIDS.


We examined the relationships between adherence to psychotropic medications, depressive symptoms, and antiretroviral adherence.


We assessed depressive symptoms among 324 people living with HIV/AIDS across a 3-month period (70% men; mean age 45 years; 90% African–American). Psychotropic and antiretroviral adherence was assessed using monthly, unannounced telephone pill counts. Multiple-regression and mediation analyses were utilized to examine associations under investigation.


Greater depressive symptoms were associated with lower antiretroviral and psychotropic medication adherence. Greater adherence to psychotropic medications regardless of medication class was positively related to higher antiretroviral adherence. Greater adherence to psychotropic medications also significantly mediated the association between depressive symptoms and antiretroviral adherence.


This study demonstrates the benefits of adherence to psychotropic medications on both depressive symptoms and antiretroviral adherence. Future work examining psychotropic medication adherence on disease outcomes in people living with HIV/AIDS is warranted.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. 1.

    Detels R, Muñoz A, McFarlane G, et al. Effectiveness of potent antiretroviral therapy on time to AIDS and death in men with known HIV infection duration. Multicenter AIDS Cohort Study Investigators. JAMA. 1998; 280: 1497–1503.

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Egger M, May M, Chêne G, et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: A collaborative analysis of prospective studies. Lancet. 2002; 360: 119–129.

    PubMed  Article  Google Scholar 

  3. 3.

    Hammer SM, Squires KE, Hughes MD, et al. A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less. AIDS Clinical Trials Group 320 Study Team. N Engl J Med. 1997; 337: 725–733.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Hogg RS, Yip B, Chan KJ, et al. Rates of disease progression by baseline CD4 cell count and viral load after initiating triple-drug therapy. JAMA. 2001; 286: 2568–2577.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Murphy EL, Collier AC, Kalish LA, et al. Viral Activation Transfusion Study Investigators. Highly active antiretroviral therapy decreases mortality and morbidity in patients with advanced HIV disease. Ann Intern Med. 2001; 135: 17–26.

    PubMed  CAS  Google Scholar 

  6. 6.

    Vlahov D, Galai N, Safaeian M, et al. Effectiveness of highly active antiretroviral therapy among injection drug users with late-stage human immunodeficiency virus infection. Am J Epidemiol. 2005; 161: 999–1012.

    PubMed  Article  Google Scholar 

  7. 7.

    Bangsberg DR. Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression. Clin Infect Dis. 2006; 43: 939–941.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Parienti JJ, Ragland K, Lucht F, et al. Average adherence to boosted protease inhibitor therapy, rather than the pattern of missed doses, as a predictor of HIV RNA replication. Clin Infect Dis. 2010; 50: 1192–1197.

    PubMed  Article  Google Scholar 

  9. 9.

    Rosenblum M, Deeks SG, van der Laan M, Bangsberg DR. The risk of virologic failure decreases with duration of HIV suppression, at greater than 50% adherence to antiretroviral therapy. PLoS One. 2009; 4: e7196.

    PubMed  Article  Google Scholar 

  10. 10.

    Arnsten JH, Li X, Mizuno Y, et al. Factors associated with antiretroviral therapy adherence and medication errors among HIV-infected injection drug users. J Acquir Immune Defic Syndr. 2007; 46: S64-71.

    PubMed  Article  Google Scholar 

  11. 11.

    Glass TR, Battegay M, Cavassini M, et al. Longitudinal analysis of patterns and predictors of changes in self-reported adherence to antiretroviral therapy: Swiss HIV Cohort Study. J Acquir Immune Defic Syndr. 2010; 54: 197–203.

    PubMed  Google Scholar 

  12. 12.

    Springer SA, Chen S, Altice F. Depression and symptomatic response among HIV-infected drug users enrolled in a randomized controlled trial of directly administered antiretroviral therapy. AIDS Care. 2009; 21: 976–983.

    PubMed  Article  Google Scholar 

  13. 13.

    Starace F, Ammassari A, Trotta MP, et al. Depression is a risk factor for suboptimal adherence to highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2002; 31: S136-139.

    PubMed  Article  Google Scholar 

  14. 14.

    Kacanek D, Jacobson DL, Spiegelman D, et al. Incident depression symptoms are associated with poorer HAART adherence: A longitudinal analysis from the Nutrition for Healthy Living Study. J Acquir Immune Defic Syndr. 2010; 53: 266–272.

    PubMed  Article  Google Scholar 

  15. 15.

    Bing EG, Burnam MA, Longshore D, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001; 58: 721–728.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Atkinson JH Jr, Grant I, Kennedy CJ, Richman DD, Spector SA, McCutchan JA. Prevalence of psychiatric disorders among men infected with human immunodeficiency virus. A controlled study. Arch Gen Psychiatry. 1988; 45: 859–864.

    PubMed  Article  Google Scholar 

  17. 17.

    Cruess DG, Evans DL, Repetto MJ, Gettes D, Douglas SD, Petitto JM. Prevalence, diagnosis, and pharmacological treatment of mood disorders in HIV disease. Biol Psychiatry. 2003; 54: 307–316.

    PubMed  Article  Google Scholar 

  18. 18.

    Ickovics JR, Hamburger ME, Vlahov D, et al. HIV Epidemiology Research Study Group. Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: Longitudinal analysis from the HIV Epidemiology Research Study. JAMA. 2001; 285: 1466–1474.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Morrison MF, Petitto JM, Ten Have T, et al. Depressive and anxiety disorders in women with HIV infection. Am J Psychiatry. 2002; 159: 789–796.

    PubMed  Article  Google Scholar 

  20. 20.

    Williams JB, Rabkin JG, Remien RH, Gorman JM, Ehrhardt AA. Multidisciplinary baseline assessment of homosexual men with and without human immunodeficiency virus infection. II. Standardized clinical assessment of current and lifetime psychopathology. Arch Gen Psychiatry. 1991; 48: 124–130.

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Burnam MA, Bing EG, Morton SC, et al. Use of mental health and substance abuse treatment services among adults with HIV in the United States. Arch Gen Psychiatry. 2001; 58: 729–736.

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Himelhoch S, Medoff DR. Efficacy of antidepressant medication among HIV-positive individuals with depression: A systematic review and meta-analysis. AIDS Patient Care STDS. 2005; 19: 813–822.

    PubMed  Article  Google Scholar 

  23. 23.

    Sambamoorthi U, Walkup J, Olfson M, Crystal S. Antidepressant treatment and health services utilization among HIV-infected medicaid patients diagnosed with depression. J Gen Intern Med. 2000; 15: 311–320.

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Dalessandro M, Conti CM, Gambi F, et al. Antidepressant therapy can improve adherence to antiretroviral regimens among HIV-infected and depressed patients. J Clin Psychopharmacol. 2007; 27: 58–61.

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Kumar V, Encinosa W. Effects of antidepressant treatment on antiretroviral regimen adherence among depressed HIV-infected patients. Psychiatr Q. 2009; 80: 131–41.

    PubMed  Article  Google Scholar 

  26. 26.

    Walkup J, Wei W, Sambamoorthi U, Crystal S. Antidepressant treatment and adherence to combination antiretroviral therapy among patients with AIDS and diagnosed depression. Psychiatr Q. 2008; 79: 43–53.

    PubMed  Article  Google Scholar 

  27. 27.

    Yun LW, Maravi M, Kobayashi JS, Barton PL, Davidson AJ. Antidepressant treatment improves adherence to antiretroviral therapy among depressed HIV-infected patients. J Acquir Immune Defic Syndr. 2005; 38: 432–438.

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Horberg MA, Silverberg MJ, Hurley LB, et al. Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy and on clinical outcomes in HIV-infected patients. J Acquir Immune Defic Syndr. 2008; 47: 384–390.

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Simoni JM, Kurth AE, Pearson CR, Pantalone DW, Merrill JO, Frick PA. Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management. AIDS Behav. 2006; 10:227–245.

    PubMed  Article  Google Scholar 

  30. 30.

    Nieuwkerk PT, Oort FJ. Self-reported adherence to antiretroviral therapy for HIV-1 infection and virologic treatment response: A meta-analysis. J Acquir Immune Defic Syndr. 2005; 38: 445–448.

    PubMed  Article  Google Scholar 

  31. 31.

    Atkinson MJ, Petrozzino JJ. An evidence-based review of treatment-related determinants of patients' nonadherence to HIV medications. AIDS Patient Care STDS. 2009; 23: 903–914.

    PubMed  Article  Google Scholar 

  32. 32.

    Fisher JD, Fisher WA. Changing AIDS-risk behavior. Psychol Bull. 1992, 111: 455–474.

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Gribble JN, Miller HG, Cooley PC, Catania JA, Pollack L, Turner CF. The impact of T-ACASI interviewing on reported drug use among men who have sex with men. Subst Use Misuse. 2000; 35: 869–890.

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Bangsberg DR, Hecht F, Charlebois E, Chesney M, Moss A. Comparing objective measures of adherence to HIV antiretroviral therapy: Electronic medication monitors and unannounced pill counts. AIDS Behav. 2001; 5: 275–281.

    Article  Google Scholar 

  35. 35.

    Kalichman SC, Amaral CM, Cherry C, et al. Monitoring antiretroviral adherence by unannounced pill counts conducted by telephone: Reliability and criterion-related validity. HIV Clinical Trials. 2008; 9: 298–308.

    PubMed  Article  Google Scholar 

  36. 36.

    Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: Evaluation of a short form of the CES—D. Am J Prev Med. 1994; 10: 77–84.

    PubMed  CAS  Google Scholar 

  37. 37.

    Yi MS, Mrus JM, Wade TJ, et al. Religion, spirituality, and depressive symptoms in patients with HIV/AIDS. J Gen Intern Med. 2006; 21: S21-27.

    PubMed  Article  Google Scholar 

  38. 38.

    Radloff LS. The CES—D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement. 1977; 1: 385–401.

    Article  Google Scholar 

  39. 39.

    Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology. 1986, 51: 1173–1182.

    PubMed  Article  CAS  Google Scholar 

  40. 40.

    Sobel ME. Asymptotic intervals for indirect effects in structural equations models. In: Leinhart S (ed) Sociological methodology. Jossey-Bass, San Francisco, pp. 290–312, 1982.

    Google Scholar 

  41. 41.

    Leserman J, Cruess DG, Petitto JM. HIV/AIDS and Mood Disorders. In Charney DS & Evans DL (eds) The physician's guide to depression and bipolar disorder. McGraw-Hill, New York, pp. 411–436, 2006.

    Google Scholar 

  42. 42.

    Burack JH, Barrett DC, Stall RD, Chesney MA, Ekstrand ML, Coates TJ. Depressive symptoms and CD4 lymphocyte decline among HIV-infected men. JAMA. 1993; 270: 2568–2573.

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Cruess DG, Douglas SD, Petitto JM, et al. Association of resolution of major depression with increased natural killer cell activity among HIV-seropositive women. Am J Psychiatry. 2005; 162: 2125–2130.

    PubMed  Article  Google Scholar 

  44. 44.

    Leserman J. HIV disease progression: Depression, stress, and possible mechanisms. Biol Psychiatry. 2003; 54: 295–306.

    PubMed  Article  Google Scholar 

  45. 45.

    Evans DL, Ten Have T, Douglas SD, et al. Depression in women with HIV-infection is associated with viral load, CD8 T cells and natural killer lymphocytes. Am J Psychiatry. 2002; 159: 1752–1759.

    PubMed  Article  Google Scholar 

  46. 46.

    Chida Y, Vedhara K. Adverse psychosocial factors predict poorer prognosis in HIV disease: A meta-analytic review of prospective investigations. Brain Behav Immunity. 2009; 23: 434–445.

    Article  Google Scholar 

Download references


This work was supported by the National Institute of Mental Health (NIMH), grant R01MH071164.

Conflict of Interest Statement

The authors have no conflict of interest to disclose.

Author information



Corresponding author

Correspondence to Dean G. Cruess Ph.D.

About this article

Cite this article

Cruess, D.G., Kalichman, S.C., Amaral, C. et al. Benefits of Adherence to Psychotropic Medications on Depressive Symptoms and Antiretroviral Medication Adherence Among Men and Women Living with HIV/AIDS. ann. behav. med. 43, 189–197 (2012).

Download citation


  • Medication adherence
  • Depression
  • HIV