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A 46 year-old African-American male co-infected with HIV and Hepatitis C virus (HCV) presents for his routine medical appointment. Incarcerated for the past three years, he often reports sadness and irritability, but has been reluctant to “take another pill.” He is prescribed a twice-daily regimen of Combivir and Kaletra and has achieved an undetectable viral load and CD4 cell count of 750 cells/mm3. This inmate has a past history of intravenous “speedballing” of heroin and cocaine, but denies prior psychotropic medication trials. With the death of his mother three months ago, he complains of a progression of his depression with persistent low mood, frequent anger episodes, insomnia with early morning awakening and passive thoughts of dying. He seems despondent but sincere in his presentation and assertions of safety. He is now agreeable to help, including medication, if necessary. How would you manage his depression and thoughts of dying? -Does his current antiretroviral regimen impact the selection of antidepressant or dosage?
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