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Guideline Summary
Guideline Title
Depression and mania in patients with HIV/AIDS.
Bibliographic Source(s)
New York State Department of Health. Depression and mania in patients with HIV/AIDS. New York (NY): New York State Department of Health; 2010 Oct. 21 p. [26 references]
Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: New York State Department of Health. Depression and mania in patients with HIV/AIDS. New York (NY): New York State Department of Health; 2008 Jun. 23 p.

Scope

Disease/Condition(s)
  • Human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS)
  • Mental disorders in HIV-infected patients:
    • Depression, including depression in pregnant and postpartum women
    • Mania
Guideline Category
Diagnosis
Evaluation
Management
Screening
Treatment
Clinical Specialty
Allergy and Immunology
Family Practice
Infectious Diseases
Internal Medicine
Obstetrics and Gynecology
Psychiatry
Intended Users
Advanced Practice Nurses
Health Care Providers
Nurses
Physician Assistants
Physicians
Public Health Departments
Guideline Objective(s)

To provide guidelines for diagnosis and treatment of depression and mania in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in primary care settings

Target Population

Patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), including pregnant and postpartum women

Interventions and Practices Considered

Depression (Screening, Diagnosis, Treatment)

  1. Screening for depression using one of the screening tool options
  2. Use of Diagnostic and Statistical Manual of Mental Disorders - IV (DSM-IV) criteria
  3. Paying specific attention to patients taking interferon-alpha and those with changes in body fat
  4. Antidepressant medications:
    • Selective serotonin reuptake inhibitors
    • Novel antidepressants
    • Tricyclic antidepressants
    • Psychostimulants
  5. Psychotherapy
  6. Alternative therapies (e.g., St. John's wort)
  7. Follow-up
  8. Management of depression in pregnant and postpartum women

Mania (Screening, Diagnosis, Treatment)

  1. Use of DSM-IV diagnostic criteria for mania
  2. Prompt referral of patients experiencing mania for psychiatric consultation
  3. Medications
  4. Combination of psychotherapy with medication
Major Outcomes Considered
  • Effectiveness of screening techniques in detecting unrecognized depression
  • Effectiveness of interventions to treat depression
  • Adverse effects of medications

Methodology

Methods Used to Collect/Select the Evidence
Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence

Not stated

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence
Expert Consensus (Committee)
Rating Scheme for the Strength of the Evidence

Not applicable

Methods Used to Analyze the Evidence
Review
Description of the Methods Used to Analyze the Evidence

Not stated

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

AIDS Institute clinical guidelines are developed by distinguished committees of clinicians and others with extensive experience providing care to people with human immunodeficiency virus (HIV) infection. Committees* meet regularly to assess current recommendations and to write and update guidelines in accordance with newly emerging clinical and research developments.

The Committees* rely on evidence to the extent possible in formulating recommendations. When data from randomized clinical trials are not available, Committees rely on developing guidelines based on consensus, balancing the use of new information with sound clinical judgment that results in recommendations that are in the best interest of patients.

*Current committees include:

  • Medical Care Criteria Committee
  • Committee for the Care of Children and Adolescents with HIV Infection
  • Dental Standards of Care Committee
  • Mental Health Guidelines Committee
  • Committee for the Care of Women with HIV Infection
  • Committee for the Care of Substance Users with HIV Infection
  • Physicians' Prevention Advisory Committee
  • Pharmacy Advisory Committee
Rating Scheme for the Strength of the Recommendations

Not applicable

Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation
External Peer Review
Description of Method of Guideline Validation

All guidelines developed by the Committee are externally peer reviewed by at least two experts in that particular area of patient care, which ensures depth and quality of the guidelines.

Recommendations

Major Recommendations

Depression

Screening for Depression

Clinicians should screen for depression as part of the annual mental health assessment and whenever symptoms suggest its presence (see Appendix I: Mental Health Screening Tools in the "Availability of Companion Documents" field for screening tool options).

See the original guideline document for simple screening techniques, symptoms of depression, and behavioral changes that may be indications of an underlying depressive disorder.

Human immunodeficiency virus (HIV)-infected patients do not become depressed simply because their disease progresses; however, it is particularly important to screen for depression during the crisis points noted in the table below.

Table: Crisis Points for HIV-Infected Persons
  • Learning of HIV-positive status
  • Disclosure of HIV status to family and friends
  • Introduction of medication
  • Occurrence of any physical illness
  • Recognition of new symptoms/progression of disease (e.g., major decrease in CD4 cells, increase in viral load)
  • Necessity of hospitalization (particularly the first hospitalization)
  • Death of a significant other
  • Diagnosis of acquired immunodeficiency syndrome (AIDS)
  • A return to a higher level of functioning (e.g., re-entry into job market/school, giving up entitlements)
  • Major life changes (e.g., childbirth, pregnancy, loss of job, end of relationship, relocation)
  • Necessity of making end-of-life and permanency planning decisions

Diagnosis

Clinicians should use the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) to diagnose depression (see table below).

Table: Diagnostic Criteria For Major Depressive Episode
  1. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

    Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

    1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).

      Note: In children and adolescents, this can be irritable mood.

    2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others).
    3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.

      Note: In children, consider failure to make expected weight gains.

    4. Insomnia or hypersomnia nearly every day.
    5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
    6. Fatigue or loss of energy nearly every day.
    7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
    8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
    9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
  1. The symptoms do not meet criteria for a mixed episode.
  2. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  3. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
  4. The symptoms are not better accounted for by bereavement (i.e., after the loss of a loved one), the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Depression and Co-Existing Medical Conditions

The primary care clinician should work closely with a psychiatrist throughout the course of treatment if depressive symptoms are associated with medication, and the benefit of continuing the medication outweighs the risk. In these situations, antidepressant therapy should be considered.

Key Point:

Patients co-infected with hepatitis C virus (HCV), patients receiving treatment with interferon, and patients with disfiguring side effects of antiretroviral therapy (ART), particularly body fat changes, are more prone to develop depressive symptoms.

Depression in Patients with HIV/Hepatitis C Co-Infection

Clinicians who prescribe interferon-alpha should screen patients for depression at least every 4 weeks while they are receiving treatment (Hauser et al., 2002).

Clinicians who prescribe interferon-alpha should consult with a psychiatrist when treating patients with a history of psychiatric disorders, including depression and substance use.

Key Point:

There is a growing amount of evidence that a history of psychiatric disorders, such as depression, does not necessarily increase the risk of developing depression while receiving interferon.

For recommendations regarding the medical management of HIV/HCV co-infected patients, refer to the National Guideline Clearinghouse (NGC) summary of the New York State Department of Health (NYSDoH) guideline Hepatitis C Virus.

Depression in Patients Experiencing Body Fat Changes

Clinicians should assess mood at every visit in patients who develop changes in body fat.

Key Point:

Patients report that clinicians minimize the importance of body fat changes.

Management of HIV-Infected Patients with Depression

Clinicians should implement interventions, such as medications or psychotherapy, for patients with moderate to severe depression or mild depression that does not resolve in 2 to 4 weeks.

Referral

Patients at high risk for suicide or other violent behavior should be referred for immediate psychiatric intervention.

Indications for referral to a psychiatrist include:

  • Depression associated with dementia, psychotic symptoms, manic symptoms
  • No response to trials of two different antidepressants
  • Worsening of symptoms despite appropriate medication
  • Requiring higher-than-usual doses of medication to control symptoms
  • Patient inability to tolerate side effects or clinician concern about side effects
  • Depressive symptoms presenting in a patient with a history of bipolar disorder

Antidepressant Medications

Clinicians should individualize therapy, considering drug-drug interactions with HIV-related medications, presence of comorbid psychiatric disorder(s), presenting symptoms, and side effect profile.

Key Point:

As in other vulnerable populations, the concept "start low, go slow" remains the cornerstone of psychiatric medication prescribing for HIV-infected patients.

Refer to Table 3 in the original guideline document for a list of commonly used antidepressants.

Refer to "Appendix II: Interactions Between HIV-Related Medications and Psychotropic Medications" in the "Availability of Companion Documents" field for side effect profile, contraindications, and drug-drug interactions.

Selective Serotonin Reuptake Inhibitors (SSRI) and Novel Antidepressant Medications

Clinicians should ask patients who are receiving SSRIs about sexual side effects.

Clinicians should monitor patients for suicidal ideation during the initiation phase of SSRI treatment. Clinicians should consider discontinuing medication in patients whose depression is persistently worse or whose emergent suicidality is severe, abrupt in onset, or was not part of the presenting symptoms.

Tricyclic Antidepressants

Clinicians should monitor serum drug levels to ensure appropriate dosing of tricyclic antidepressants when there are concerns about adherence, absorption, or drug interactions.

Psychotherapy

Clinicians should refer patients for psychotherapy in the following situations:

  • When basic supportive psychoeducational interventions are deemed ineffective in alleviating mood symptoms
  • When patients with depressive symptoms refuse (or prefer not to take) recommended psychotropic medication
  • When situational events precipitate mild to moderate depressive symptoms
  • When patients appear to have difficulty accepting the diagnosis of a mood disorder (especially when this appears to cause high-risk behavior or non-adherence to medication)
  • When patients request a referral
Key Point:

Combining psychotherapy with antidepressant and mood-stabilizing medications is the most effective treatment option for many patients. If treatment with medications is not possible (e.g., some patients in recovery are opposed to taking psychotropic medications), psychotherapy alone may be as effective as medication in cases of mild to moderate depression.

Alternative Therapies for Depression

Clinicians should inform patients who decide to use alternative treatments of the following:

  • Drug interactions and toxicities may occur.
  • These treatments may take longer to be effective.
  • These medications are not well studied.

Clinicians should inform patients that concomitant use of St. John's Wort with protease inhibitors (PIs) or non-nucleoside reverse transcriptase inhibitors (NNRTIs) is contraindicated because it may lead to subtherapeutic ART drug concentrations.

Treatment Follow-Up

After initiating treatment, clinicians should schedule a brief visit or phone conversation every 1 to 2 weeks to support adherence, assess response and side effects, and remind the patient that it may take 3 weeks or longer for mood to improve. After 3 to 4 weeks, the clinician should perform an in-person assessment of symptom improvement.

During the maintenance phase of treatment with antidepressant medication, clinicians should schedule a brief visit every 4 to 12 weeks to assess adherence, sustained therapeutic response, and side effects.

After referring patients to another provider for medication or psychotherapy, primary care clinicians should schedule a brief visit or phone conversation within 1 to 4 weeks after the referral to ensure that the patient followed through (Simon at al., 2004).

Clinicians should encourage patients who experience recurrent depression to remain on medication indefinitely.

Primary care clinicians should maintain ongoing coordination of care with the patient's mental health care provider.

Treatment of Depression in Pregnant Women

Clinicians should screen all HIV-infected pregnant women for depression at least once each trimester, including the first prenatal visit, and should educate patients about the risks of perinatal depression.

When treatment is indicated, clinicians and HIV-infected pregnant women should discuss the risks and benefits of antidepressant therapy. The discussion should include the following:

  • Patient's history of depression
  • Patient's past response to medication
  • Increased risk for postpartum depression
  • Risks of prenatal exposure to psychotropic medication versus the benefit of stabilizing the patient's depressive symptoms
  • Possible drug-drug interactions between antidepressants and ART medications

Clinicians should evaluate pregnant patients for the use of antidepressant medication, alone or in combination with nonpharmacologic treatment, when patients present with moderate to severe depression, a history of postpartum depression, or recurrent major depression.

Primary care clinicians should refer HIV-infected pregnant women with depression to a psychiatrist when treatment considerations are complicated by:

  • The presence of a co-occurring mental health disorder or when the patient's depression is a feature of an underlying mental health disorder
  • Previous non-response to antidepressive therapy
  • Possible drug-drug interactions with other medications
  • Allergic reactions to antidepressant medications

Refer to Table 4 in the original guideline document for considerations for psychotropic medications during pregnancy.

Screening and Treatment of Postpartum Depression

Primary care clinicians or obstetrical care providers should screen for postpartum depression in HIV-infected women at the routine 4- to 6-week postpartum obstetrical visit; a depression screen should also be performed at 2 to 3 weeks postpartum in women with a current or previous diagnosis of depression.

All clinicians involved in the care of the mother and newborn (e.g., the obstetrician, the HIV primary care clinician, the pediatrician) should be vigilant for signs and symptoms of postpartum depression. If the mother is identified as having postpartum depression, the identifying clinician should inform all other providers of the mother's depression after obtaining her consent.

Key Point:

Because pediatricians see the mother and infant more often in the first few weeks postpartum, they are in a unique position to detect depressive symptoms in mothers, including difficulty forming a maternal bond with the infant.

Mania

Clinicians should immediately refer patients experiencing mania for psychiatric evaluation and care.

Diagnosis

Clinicians should consult with or refer patients to a psychiatrist when there is doubt concerning the diagnosis.

Clinicians should consult with or refer patients to a psychiatrist when it is not clear whether patients are hypomanic or depressed.

Clinicians should use the DSM-IV diagnostic criteria for mania (see table below).

Table: Diagnostic Criteria for Manic Episode
  1. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).
  2. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
    1. Inflated self-esteem or grandiosity
    2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
    3. More talkative than usual or pressure to keep talking
    4. Insomnia or hypersomnia nearly every day
    5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
    6. Flight of ideas or subjective experience that thoughts are racing
    7. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
    8. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
    9. Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
  1. The symptoms do not meet criteria for a mixed episode.
  2. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
  3. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Diagnostic Criteria for Mixed Episode
  1. The criteria are met both for a manic episode and for a major depressive episode (except for duration) nearly every day during at least a 1-week period.
  2. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
  3. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Diagnostic Criteria for Hypomanic Episode
  1. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
  2. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
    1. Inflated self-esteem or grandiosity
    2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
    3. More talkative than usual or pressure to keep talking
    4. Flight of ideas or subjective experience that thoughts are racing
    5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
    6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
    7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
  1. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
  2. The disturbance in mood and the change in functioning are observable by others.
  3. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
  4. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of bipolar II disorder.

Management of HIV-Infected Patients with Mania

Until patients with mania are stabilized, clinicians should maintain consultation with a psychiatrist or the patient should be under psychiatric care.

Medications

Key Point:

Treating hypomanic patients with antidepressants may lead to a full-blown episode of mania.

Refer to Table 6 in the original guideline document for commonly used medications to treat mania.

Clinical Algorithm(s)

An algorithm is provided in the original guideline document for screening and managing suicidal or violent patients is available in the quick reference guide (see the "Availability of Companion Documents" field).

Evidence Supporting the Recommendations

References Supporting the Recommendations
Type of Evidence Supporting the Recommendations

The type of supporting evidence is not specifically stated for each recommendation.

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits
  • Appropriate screening, diagnosis, and treatment of depression and mania in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)
  • Simple screening techniques tested in a general primary care setting have been shown to be effective in detecting unrecognized depression.
  • Mild depression may resolve within 2 to 4 weeks with support and education alone. For some patients, medication alone may be sufficient to ease their depression; for others, the combination of medication and psychotherapy will provide a more effective and perhaps faster response.
Potential Harms
  • For many people, the most troubling side effect of selective serotonin reuptake inhibitors (SSRIs) is sexual dysfunction (e.g., anorgasmia, decreased libido, or erectile and ejaculatory dysfunction). Dose reductions, drug holidays, or switching to another drug in the same class may ease these effects and, therefore, improve adherence.
  • Tricyclic antidepressants (TCAs) have anticholinergic side effects, such as sedation and constipation, which may be useful to patients suffering from insomnia and chronic diarrhea, respectively. TCAs also cause weight gain and may be useful in treating neuropathic pain. However, HIV-infected patients, particularly those with more advanced disease, are more sensitive to and less able to tolerate anticholinergic side effects of TCAs. Anticholinergic effects include dry mouth, blurred vision, cognitive impairment, or orthostasis and may lead to non-adherence or treatment failure.
  • Currently there is debate about whether antidepressants play a role in worsening depression and causing the emergence of suicidality in certain patients. It is particularly important to monitor patients for suicidal ideation during the initiation phase of treatment. Clinicians should consider discontinuing medication in patients whose depression is persistently worse or whose emergent suicidality is severe, abrupt in onset, or was not part of the presenting symptoms. All psychotropic medications should be stopped slowly.
  • An increased risk for preterm birth has been noted with all antidepressants. Although the health risks associated with these psychotropic medications are considered low, other adverse effects during pregnancy are listed in Table 4 of the original guideline document.
  • Drug interactions between drugs with serotonergic activity may result in serotonin syndrome, a potentially dangerous reaction characterized by autonomic instability, neuromotor hyperactivity, and mental status changes.
  • The treatment of both AIDS mania and bipolar disorder in sicker patients requires even more careful attention to medication toxicity, drug interactions, and adherence. Use of a single agent, usually an antipsychotic medication, if possible, may be preferable. Lithium is problematic because of risk of central nervous system (CNS) toxicity and difficulty maintaining therapeutic serum drug levels, even when medication-taking is supervised. The "atypical" antipsychotic medications are more commonly used because of their more favorable side effect profiles and tolerability. Some mood stabilizers have significant associated liver and bone marrow disorders.
  • Refer to Appendix II External Web Site Policy: interactions between HIV-related medications and psychotropic medications in the "Availability of Companion Documents" field for side effect profile and drug-drug interactions.

Contraindications

Contraindications
  • Concomitant use of St. John's wort with protease inhibitors (PIs) or non-nucleoside reverse transcriptase inhibitors (NNRTIs) is contraindicated because it may lead to subtherapeutic antiretroviral therapy (ART) drug concentrations.
  • Refer to Appendix II External Web Site Policy: interactions between HIV-related medications and psychotropic medications in the "Availability of Companion Documents" field for contraindications between human immunodeficiency virus (HIV)-related medications and psychotropic medications.

Qualifying Statements

Qualifying Statements

When formulating guidelines for a disease as complex and fluid as human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), it is impossible to anticipate every scenario. It is expected that in specific situations, there will be valid exceptions to the approaches offered in these guidelines and sound reason to deviate from the recommendations provided within.

Implementation of the Guideline

Description of Implementation Strategy

The AIDS Institute's Office of the Medical Director directly oversees the development, publication, dissemination and implementation of clinical practice guidelines, in collaboration with The Johns Hopkins University, Division of Infectious Diseases. These guidelines address the medical management of adults, adolescents and children with human immunodeficiency virus (HIV) infection; primary and secondary prevention in medical settings; and include informational brochures for care providers and the public.

Guidelines Dissemination

Guidelines are disseminated to clinicians, support service providers and consumers through mass mailings and numerous AIDS Institute-sponsored educational programs. Distribution methods include the HIV Clinical Resource website, the Clinical Education Initiative (CEI), the AIDS Educational Training Centers (AETC) and the HIV/AIDS Materials Initiative. Printed copies of clinical guidelines are available for order from the New York State Department of Health (NYSDoH) Distribution Center for providers who lack internet access.

Guidelines Implementation

The HIV Clinical Guidelines Program works with other programs in the AIDS Institute to promote adoption of guidelines. Clinicians, for example, are targeted through the CEI and the AETC. The CEI provides tailored educational programming on site for health care providers on important topics in HIV care, including those addressed by the HIV Clinical Guidelines Program. The AETC provides conferences, grand rounds and other programs that cover topics contained in AIDS Institute guidelines.

Support service providers are targeted through the HIV Education and Training initiative which provides training on important HIV topics to non-physician health and human services providers. Education is carried out across the State as well as through video conferencing and audio conferencing.

The HIV Clinical Guidelines Program also works in a coordinated manner with the HIV Quality of Care Program to promote implementation of HIV guidelines in New York State. By developing quality indicators based on the guidelines, the AIDS Institute has created a mechanism for measurement of performance that allows providers and consumers to know to what extent specific guidelines have been implemented.

Finally, best practices booklets are developed through the HIV Clinical Guidelines Program. These contain practical solutions to common problems related to access, delivery or coordination of care, in an effort to ensure that HIV guidelines are implemented and that patients receive the highest level of HIV care possible.

Implementation Tools
Clinical Algorithm
Quick Reference Guides/Physician Guides
Resources
Slide Presentation
For information about availability, see the Availability of Companion Documents and Patient Resources fields below.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Getting Better
Living with Illness
IOM Domain
Effectiveness

Identifying Information and Availability

Bibliographic Source(s)
New York State Department of Health. Depression and mania in patients with HIV/AIDS. New York (NY): New York State Department of Health; 2010 Oct. 21 p. [26 references]
Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released
2005 Feb (revised 2010 Oct)
Guideline Developer(s)
New York State Department of Health - State/Local Government Agency [U.S.]
Source(s) of Funding

New York State Department of Health

Guideline Committee

Mental Health Guidelines Committee

Composition of Group That Authored the Guideline

Committee Chair: Milton L Wainberg, MD, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York

Members: Bruce D Agins, MD, MPH, New York State Department of Health AIDS Institute, New York, New York; Alison Altschuller, NP, Community Healthcare Network, Brooklyn, New York; Kenneth B Ashley, MD, Beth Israel Medical Center, New York, New York; Barbara A Conanan, RN, MS, Lutheran Family Health Centers, Brooklyn, New York; Joseph Z Lux, MD, Bellevue Hospital, New York, New York; Peter Meacher, MD, AAHIVS, FAAFP, South Bronx Health Center for Children and Families, Bronx, New York; Joseph P Merlino, MD, MPA, Kings County Hospital Center, Brooklyn, New York; Warren Yiu Kee Ng, MD, New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York; Khakasa H Wapenyi, MD, Mount Sinai Comprehensive Health Program – Downtown, New York, New York; Rachel Wolfe, PhD, St Luke's-Roosevelt Hospital Center, New York, New York

Liaisons: Mark V Bradley, MD, Liaison to the Department of Veterans Affairs Medical Center, New York Veterans Affairs Hospital, New York, New York; Francine Cournos, MD, Liaison to the New York and New Jersey AIDS Education and Training Center, Columbia University College of Physicians and Surgeons, Mailman School of Public Health, New York, New York; James J Satriano, PhD, Liaison to the New York State Office of Mental Health, Columbia University College of Physicians and Surgeons, New York, New York

AIDS Institute Staff Liaison: L Jeannine Bookhardt-Murray, MD, Harlem United Community AIDS Center, New York, New York

AIDS Institute Representative: Heather A Duell, LMSW, Bureau of Community and Support Services, New York State Department of Health AIDS Institute, Albany, New York

Alternate Committee Member: Denise E Leung, MD, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York

Principal Contributors: Francine Rainone, PhD, DO, MS, Montefiore Medical Center, Bronx; L Jeannine Bookhardt-Murray, MD, Harlem United Community AIDS Center, New York; Milton L Wainberg, MD, Columbia University, New York; Gina M Brown, MD, New York City Department of Health and Mental Hygiene, New York

Financial Disclosures/Conflicts of Interest

Not stated

Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: New York State Department of Health. Depression and mania in patients with HIV/AIDS. New York (NY): New York State Department of Health; 2008 Jun. 23 p.

Guideline Availability

Electronic copies: Available from the New York State Department of Health AIDS Institute Web site External Web Site Policy.

Availability of Companion Documents

The following are available:

Patient Resources

None available

NGC Status

This NGC summary was completed by ECRI on May 5, 2005. This summary was updated by ECRI Institute on November 9, 2007, following the U.S. Food and Drug Administration advisory on Antidepressant drugs. This guideline was updated by ECRI Institute on September 2, 2008. This NGC summary was updated by ECRI Institute on October 27, 2011. This summary was updated by ECRI Institute on April 16, 2012 following the updated U.S. Food and Drug Administration advisory on Celexa (citalopram hydrobromide).

Copyright Statement

This NGC summary is based on the original guideline, which is copyrighted by the guideline developer. See the New York State Department of Health AIDS Institute Web site External Web Site Policy for terms of use.

Disclaimer

NGC Disclaimer

The National Guideline Clearinghouseâ„¢ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

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