The goal of this study is to evaluate a rapid, inexpensive, practical intervention for patients with syndromal depression accompanied by debilitating low energy in the context of late stage HIV illness. While standard antidepressants have been shown to be effective in late stage HIV illness, factors such as fatigue, mobility, and need for rapidly effective treatment continue to be problematic in this patient group. The proposed study consists of a 2-week double-blind placebo controlled phase, and then open treatment for the remainder of 6 months. Nonresponders will be removed from the protocol at the end of Week 2 and treated openly as clinically indicated while responders will be maintained on double-blind drug until week 8 or relapse. The proposed sample will include 40 mobile and 40 homebound men and women with AIDS. Patients with late stage HIV illness are living longer and are more often managed at home, given increased restrictions on hospital stays by third party payers and greater availability of homecare nursing agencies. Those who remain mobile and ambulatory may seek outpatient psychiatric treatment, but attendance may be sporadic because of health and energy problems. Homebound patients seldom have access to psychiatric interventions for mood-related problems. The intent of this study is to evaluate this treatment for both mobile and homebound patients to determine whether the treatment is effective and tolerable in these two subpopulations. Treatment of depression not only promotes quality of life and well-being, but may also promote effective medical management and more cost effective treatment by enabling medically ill patients to remain at home rather than to be hospitalized.
| Wagner, G J; Rabkin, R (2000) Effects of dextroamphetamine on depression and fatigue in men with HIV: a double-blind, placebo-controlled trial. J Clin Psychiatry 61:436-40 |
