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Psychopharmacological Treatment of Patients with HIV and AIDS

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Abstract

Psychopharmacological treatment of patients with HIV/AIDS is an important aspect of managing distress and enhancing quality of life. This article reviews the psychopharmacological management of depression, anxiety, mania, and psychosis in the context of HIV/AIDS, with a discussion of psychotropic–antiretroviral drug interactions. While psychopharmacological management of HIV/AIDS patients may be complex, there is a substantial amount of clinical and research information describing both conventional and novel approaches that are safe and effective.

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REFERENCES

  1. Work Group on HIV/AIDS. Practice Guidelines for the Treatment of Patients With HIV/AIDS. American Journal of Psychiatry 157:11, 2000.

    Google Scholar 

  2. Rabkin JG, Rabkin R, Harrison W, et al.: Effect of imipramine on mood and enumerative measures of immune status in depressed patients with HIV illness. American Journal of Psychiatry 151(4):516-523, 1994.

    Google Scholar 

  3. ManningD, Jacobsberg L, Erhart S, et al.: The efficacy of imipramine in the treatment of HIV-related depression. International Conference on AIDS (Abstract No. Th.B.32), June 20-23, 1990.

  4. Rabkin JG, Rabkin R, Wagner G: Effects of fluoxetine on mood and immune status in depressed patients with HIV illness. Journal of Clinical Psychiatry 55(3):92-97, 1994.

    Google Scholar 

  5. Rabkin JG, Wagner G, Rabkin R: Effects of sertraline on mood and immune status in patients with major depression and HIV illness: An open trial. Journal of Clinical Psychiatry 55(1):433-439, 1994.

    Google Scholar 

  6. Ferrando SJ, Goldman JG, Charness W: SSRI treatment of depression in symptomatic HIV infection and AIDS: Improvements in affective and somatic symptoms. General Hospital Psychiatry 19:89-97, 1997.

    Google Scholar 

  7. Rabkin JG, Wagner GJ, Rabkin R: Fluoxetine treatment for depression in patients with HIV and AIDS: A randomized, placebo-controlled trial. American Journal of Psychiatry 156:101-107, 1999.

    Google Scholar 

  8. Batki SL, Manfredi LB, Murphy JM, et al.: Fluoxetine treatment of cocaine abuse and depression in HIV-infected injection drug users. International Conference on AIDS Abstract PO-B16-1685, 1993.

  9. Elliott AJ, Uldall KK, Bergam K, et al.: Randomized, placebo-controlled trial of paroxetine versus imipramine in depressed HIV-positive outpatients. American Journal of Psychiatry 155(3):367-372, 1998.

    Google Scholar 

  10. Zisook S, Peterkin J, Goggin KJ, et al.: Treatment of major depression in HIVseropositive men. Journal of Clinical Psychiatry 59:217-224, 1998.

    Google Scholar 

  11. Markowitz JC, Kocsis JH, Fishman B, et al.: Treatment of depressive symptoms in human immunodeficiency virus-positive patients. Archives of General Psychiatry 55:452-457, 1998.

    Google Scholar 

  12. Schwartz JAJ, McDaniel JS: Double-blind comparison of fluoxetine and desipramine in the treatment of depressed women with advanced HIV disease: A pilot study. Depression and Anxiety 9:70-4, 1999.

    Google Scholar 

  13. Ferrando SJ, Rabkin JG, de Moore G, et al.: Antidepressant treatment of depression in HIV+ women. Journal of Clinical Psychiatry 60:741-746, 1999.

    Google Scholar 

  14. Elliott AJ, Russo J, Bergam K, et al.: Antidepressant efficacy in HIV-seropositive outpatients with major depressive disorder: An open trial of nefazodone. Journal of Clinical Psychiatry 60:226-231, 1999.

    Google Scholar 

  15. Elliott AJ, Roy-Byrne PP: Mirtazapine for depression in patients with human immunodeficiency virus (letter). Journal of Clinical Psychopharmacology 20:265-267, 2000.

    Google Scholar 

  16. Fernandez F, Levy J: Efficacy of venlafaxine in HIV-depressive disorders. Psychosomatics 38:173-74, 1997.

    Google Scholar 

  17. Holmes Fernandez F, Levy JK: Psychostimulant response in AIDS-related complex patients. Journal of Clinical Psychiatry 50:5-8, 1989.

    Google Scholar 

  18. Wagner GJ, Rabkin JG, Rabkin R: Dextroamphetamine as a treatment for depression and low energy in AIDS patients: A pilot study. Journal of Psychosomatic Research 42(4):407-411, 1997.

    Google Scholar 

  19. Wagner GJ, Rabkin R: Effects of dextroamphetamine on depression and fatigue in men with HIV: A double-blind, placebo-controlled trial. Journal of Clinical Psychiatry 61(6):436-440, 2000.

    Google Scholar 

  20. Breitbart W, Rosenfeld B, Kaim M, et al.: A randomized, double-blind, placebo-controlled trial of psychostimulants for the treatment of fatigue in ambulatory patients with human immunodeficiency virus disease. Archives of Internal Medicine 161(3):411-20, 2001.

    Google Scholar 

  21. Rabkin JG, Wagner GJ, Rabkin R: Testosterone therapy for human immunodeficiency virus-positive men with and without hypogonadism. Journal of Clinical Psychopharmacology 19(1):19-27, 1999.

    Google Scholar 

  22. Rabkin JG, Ferrando SJ, Wagner G, et al.: DHEA treatment of men and women with HIV infection. Psychoneuroendocrinology 25:53-68, 2000.

    Google Scholar 

  23. Rabkin JG, Wagner GJ, Rabkin R: A double-blind, placebo-controlled trial of testosterone therapy for HIV-positive men with hypogonadal symptoms. Archives of General Psychiatry 57:141-7, 2000.

    Google Scholar 

  24. Cerngul I, Jones K, Ernst J: S-adenosylmethionine (SAM-e) in the treatment of depressive disorders in HIV-positive individuals: Interim results. AMFAR's 13th International HIV/AIDS Update Conference, San Francisco, CA, March 20-23, 2001.

  25. Wagner GJ, Rabkin JG, Rabkin R: A comparative analysis of standard and alternative antidepressants in the treatment of human immunodeficiency virus patients. Comprehensive Psychiatry 37:402-408, 1996.

    Google Scholar 

  26. Sewell M, Goggin K, Ferrando SJ, et al.: Anxiety among men with AIDS: a longitudinal controlled study. Psychosomatics 4:294-300, 2000.

    Google Scholar 

  27. Hirsch DA, Fishman J, Jacobsen P, et al.: Treatment of Anxiety in HIV positive asymptomatic men with buspirone. International Conference on AIDS 6: Abstract S.B. 395, 1990.

  28. Batki SL: Buspirone in drug users with AIDS or AIDS-related complex. Journal of Clinical Psychopharmacology 10:111S-115S, 1990.

    Google Scholar 

  29. Lyketsos CG, Schwartz J, Fishman M, et al.: AIDS Mania. Journal of Neuropsychiatry 9:277-279, 1997.

    Google Scholar 

  30. Mijch AM, Judd FK, Lyketsos CG, et al.: Secondary Mania in Patients With HIV Infection: Are Antiretrovirals Protective? Journal of Neuropsychiatry and Clinical Neurosciences 11:475-480, 1999.

    Google Scholar 

  31. Bipolar Disorder Guideline Reviewers and Consultants. American Psychiatric Association Practice Guidelines on the Treatment of Bipolar Disorder. Treatment Principles and Alternatives. www.psych.org. 1994.

  32. Jennings HR, Romanelli F. The use of valproic acid in HIV-positive patients. Annals of Pharmacology 33:1113-1116, 1999.

    Google Scholar 

  33. Tanquary J: Lithium-induced neurotoxicity at therapeutic levels in an AIDS patient. Journal of Nervous and Mental Diseases 1993;181:519-519.

    Google Scholar 

  34. Halman MH, Worth JL, Sanders KM, et al.: Anticonvulsant use in the treatment of manic syndromes in patients with HIV-1 infection. Journal of Neuropsychiatry and Clinical Neurosciences 5:430-434, 1993.

    Google Scholar 

  35. RachBeisel JA, Weintraub E: Valproic acid treatment of AIDS-related mania. Journal of Clinical Psychiatry 58:406-407, 1997.

    Google Scholar 

  36. Cozza KL, Swanton EJ, Humphreys CW: Hepatotoxicity with combination of valproic acid, ritonavir, and nevirapine: A case report. Psychosomatics 41:452-453, 2000.

    Google Scholar 

  37. Singh AN, Catalan J: Risperidone in HIV-related manic psychosis. Lancet 344: 1029-1030, 1994.

    Google Scholar 

  38. Budman CL, Vandersall TA: Clonazepam treatment of acute mania in an AIDS patient. Journal of Clinical Psychiatry 51:212, 1990.

    Google Scholar 

  39. Mauri MC, Fabiano L, Bravin S, et al.: Schizophrenic patients before and after HIV infection: a case-control study. Encephale 23:437-441, 1997.

    Google Scholar 

  40. Sewell DD, Jeste DV, McAdams LA, et al.: Neuroleptic treatment of HIV-associated psychosis. HNRC group. Neuropsychopharmacology 10:223-229, 1994.

    Google Scholar 

  41. Fernandez F, Levy JK: The use of molindone in the treatment of psychotic and delirious patients infected with the human immunodeficiency virus. Case reports. General Hospital Psychiatry 15:31-35, 1993.

    Google Scholar 

  42. Lera G, Zirulnik J: Pilot study with clozapine in patients with HIV-associated psychosis and drug-induced parkinsonism. Movement Disorders 14:128-131, 1999.

    Google Scholar 

  43. Singh AN, Golledge H, Catalan J: Treatment of HIV-related psychotic disorders with risperidone: a series of 21 cases. Journal of Psychosomatic Research 42:489-493, 1997.

    Google Scholar 

  44. Meyer JM, Marsh J, Simpson G: Differential sensitivities to risperidone and olanzapine in a human immunodeficiency virus patient. Biological Psychiatry 44:791-794, 1998.

    Google Scholar 

  45. Dettling M, Muller-Oerlinghausen B, Britsch P: Clozapine treatment of HIVassociated psychosis-too much bone marrow toxicity? Pharmacopsychiatry 31:156-157, 1998.

    Google Scholar 

  46. Zilikis N, Nimatoudis I, Kiosses V, et al.: Treatment with risperidone of an acute psychotic episode in a patient with AIDS. General Hospital Psychiatry 20:384-385, 1998.

    Google Scholar 

  47. Breitbart W, Marotta R, Platt M, et al.: A double-blind trial of haloperidol, chlorpromazine and lorazepam in the treatment of delirium in hospitalized AIDS patients. American Journal of Psychiatry 153:231-237, 1996.

    Google Scholar 

  48. Scamvougeras A, Rosebush PI: AIDS-related psychosis with catatonia responding to low-dose lorazepam. Journal of Clinical Psychiatry 53:414-415, 1992.

    Google Scholar 

  49. Ritonavir package insert.

  50. Ouellet D, Hsu A, Qian J, Lamm JE, et al.: Effect of fluoxetine on pharmacokinetics of ritonavir. Antimicrobial Agents and Chemotherapeutics 42:3107-3112, 1998.

    Google Scholar 

  51. St. John's Wort and HAART (news). AIDS Patient Care and STDs 14:281, 2000.

    Google Scholar 

  52. Greenblatt DJ, von Moltke LL, Harmatz JS, et al.: Alprazolam-ritonavir interaction: Implications for product labeling. Clinical Pharmacology and Therapeutics 67(4):335-341, 2000.

    Google Scholar 

  53. Greenblatt DJ, von Moltke LL, Harmatz JS, et al.: Differential impairment of triazoloam and zolpidem clearance by ritonavir. Journal of Acquired Immune Deficiency Syndrome and Human Retrovirology 24:129-136, 2000.

    Google Scholar 

  54. Hsu A, Granneman GR, Carothers L, et al.: Ritonavir does not increase methadone exposure in healthy volunteers. Conference on Retroviruses and Opportunistic Infections, 5:143, (abstract no. 342), February 1-5, 1998.

    Google Scholar 

  55. Geletko SM, Erickson AD: Decreased methadone effect after ritonavir initiation. Pharmacotherapy 20(1):93-94, 2000.

    Google Scholar 

  56. Altice FL, Cooney E, Friedland GH: Nevirapine induced methadone withdrawal: Implications for antiretroviral treatment of opiate dependent HIV infected patients. Conference on Retroviruses and Opportunistic Infections, 6:137 (abstract no. 372) January 31-Feb 4, 1999.

    Google Scholar 

  57. Iribarne C, Berthou F, Carlhant D, et al.: Inhibition of methadone and buprenorphine n-dealkylations by three HIV-1 protease inhibitors. Drug Metabolism and Disposition 26:257-260, 1998.

    Google Scholar 

  58. Jatlow P, McCance EF, Rainey, et al.: Methadone increases zidovudine exposure in HIV-infected injection drug users (ACTG 262). Conference on Retrovirology and Opportunistic Infections, 3rd. Jan 28-Feb 1, Abstract #129, 1996.

  59. Rainey PM, Friedland G, McCance-Katz EF, et al.: Interaction of methadone with didanosine and stavudine. Journal of Acquired Immune Deficiency Syndrome and Human Retrovirology 24:241-248, 2000.

    Google Scholar 

  60. Bartt R: An effect of anticonvulsants on antiretroviral therapy. Neuroscience of HIV infection. Journal of Neurovirology, Jun 3-6;4(suppl):340, 1998.

    Google Scholar 

  61. Hugen PW, Burger DM, Brinkman, et al.: Carbamazepine-indinavir interaction causes antiretroviral therapy failure. Annals of Pharmacotherapy 34:465-670, 2000.

    Google Scholar 

  62. Brooks J, Daily J, Schwamm L: Protease inhibitors and anticonvulsants. AIDS Clinical Care 9:87-90, 1997.

    Google Scholar 

  63. Lertora JJL, Rege AB, Greenspan DL, et al.: Pharmacokinetic interaction between zidovudine and valproic acid in patients infected with human immunodeficiency virus. Clinical Pharmacology and Therapeutics 56:272-278, 1994.

    Google Scholar 

  64. Akula SK, Rege AB, Dreisbach AW, et al.: Valproic acid increases Cerebrospinal fluid zidovudine levels in a patient with AIDS. American Journal of Medical Science 313:244-246, 1997.

    Google Scholar 

  65. Muirhead GJ, Wulff MB, Fielding A, et al.: Pharmacokinetic interactions between sildenafil and saquinavir/ritonavir. British Journal of Clinical Pharmacology 50:99-107, 2000.

    Google Scholar 

  66. Merry C, Barry MG, Ryan M, et al.: Interaction of sildenafil and indinavir when coadministered to HIV-positive patients. AIDS 13:F101-107, 1999.

    Google Scholar 

  67. Mirken B: Danger: Possibly fatal interactions between ritonavir and "ecstasy," some other psychoactive drugs. AIDS Treatment News (abstract no. 265(5) February 21, 1997.

  68. Hales G, Roth N, Smith D: Possible fatal interaction between protease inhibitors and methamphetamine (letter). Antiviral Therapy 5:19, 2000.

    Google Scholar 

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Authors and Affiliations

  1. New York Presbyterian Hospital, Weill Medical College of Cornell University, USA

    Stephen J. Ferrando & Khakasa Wapenyi

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  1. Stephen J. Ferrando
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Ferrando, S.J., Wapenyi, K. Psychopharmacological Treatment of Patients with HIV and AIDS. Psychiatr Q 73, 33–49 (2002). https://doi.org/10.1023/A:1012840717735

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