As early as 1981, sufficient published evidence showed that lithium and antidepressants stimulate immune function to defeat a wide range, if not all microbes.  The date was auspicious, coinciding as it did with the emergence of the human immunodeficiency syndrome (AIDS). Were medicine strictly confined to healers and the ailing, and free of venture capitalists, politicians, media, corrupt academicians, lawyers, and regulatory agencies, these medications would rapidly have been adapted to AIDS. 

Over time I realized that antidepressants are far more likely to be effective in AIDS than lithium, and that measuring the viral load of AIDS patients taking antidepressants would be a powerful and objective measure of efficacy. Lacking the resources to do this, I was also unable to sell the idea to anyone. In February 2009, researchers at the Langley Porter Psychiatric Institute in San Francisco reported that antidepressants greatly improve the ability of HIV+ people with depression, and treated with antiretrovirals, to achieve and maintain undetectable viral loads. Using statistical methods that are completely foreign to me, the researchers concluded that the antidepressants were not asserting a direct antiviral effect, but improving adherence to taking antivirals. Whatever their interpretation, the fact remains than antidepressants have power inhibitory effects on viral replication. As the vast majority of physicians are unaware of this, it would not have entered the thinking of the Langley Porter team.

Were one to believe than antidepressants reduce the viral load in HIV+ individuals, it would make a big difference to know how they do it. This is how. Prostaglandins are tiny signalers that self-regulate every cell, including those of the brain and the immune system. When prostaglandins are made in excess, they depress immune function and activate viruses. The replication of HIV involves a number of steps, each of which requires increased prostaglandin production. Antidepressants are powerful inhibitors of prostaglandins, and prevent viral replication at every step. Generalized overproduction of immunosuppressive prostaglandins is believed to be responsible for the defective immune function that is the hallmark of AIDS. The withholding of antidepressants/immunostimulants from individuals with HIV or AIDS may emerge as one of history’s great iniquities.  

 Julian Lieb, M.D is a retired Yale medical school psychiatry professor, now specializing in the immunopharmacology of infectious disorders and cancer. He has authored or coauthored forty-five professional articles and nine books.