EFFECTS OF FLUOXETINE ON MOOD AND IMMUNE STATUS IN DEPRESSED-PATIENTSWITH HIV ILLNESS

Background: When present, depression in the context of human immunodef iciency virus (HIV) illness not only detracts from quality of remainin g life but may interfere with motivation to obtain good medical care a s well, thus directly influencing life's duration. This study was unde rtaken to assess the efficacy of fluoxetine in treating depression occ urring in the context of HIV illness and to assess effects, if any, of fluoxetine on immune status (T-cell subsets). Method: Patients had or iginally participated in a double-blind, placebo-controlled, 6-week st udy of imipramine. Imipramine nonresponders or relapsers and side effe ct dropouts were offered open treatment with fluoxetine for 12 weeks. Adjunctive dextroamphetamine was prescribed if the treating psychiatri st considered it clinically indicated. Eligibility criteria for the or iginal study included a DSM-III-R diagnosis of major depression, dysth ymia, or both. Concurrent HIV medications were permitted. Results: Mea sures included the clinician-rated Hamilton Rating Scale for Depressio n and Clinical Global Impressions Scale, and patient-rated Brief Sympt om Inventory and Beck Hopelessness Scale. Of the 23 patients receiving only fluoxetine, 83% (N = 19) were classified as responders. Of the 7 (30%) who also received adjunctive dextroamphetamine, all responded. Patients with CD4 cell counts under 200/cu mm did as well as others. C D4 cell count was not influenced by duration of treatment with fluoxet ine; the average decline was that expected due to the passage of time alone. Side effects were mild and relatively infrequent. Conclusion: I n this open treatment study, fluoxetine alone and fluoxetine plus dext roamphetamine were found to be effective treatments for patients with HIV illness and Axis I depression, regardless of the initial level of immune deficiency or number or type of HIV medications used concurrent ly. No negative effects on immune status were observed.