Researchers have understood for a while that people with chronic health conditions, such as heart disease, are at higher risk of developing depression. The same is true for people with symptoms of COVID-19 that last for several months and sometimes years.
An estimated 28% of adults in the United States who have had acute COVID-19 infections say they have dealt with prolonged COVID at one point, according to the most recent survey data from the US Census Bureau. Long-term COVID occurs when a constellation of symptoms persists just after the initial illness. These effects are more common in the elderly, women, hospitalized patients, and in unvaccinated people. Symptoms can vary, but include exhaustion, brain fog, dizziness, bowel problems, heart palpitations, sexual problems, changes in sense of smell or taste, thirst, chronic cough, chest pain, muscle spasms, and a worsening of symptoms afterward. of any kind of physical or mental exertion.
In June, the US Department of Health and Human Services issued a warning that prolonged COVID can have "devastating effects on the mental health of those who have it, as well as their families," whether from the disease itself or due to social isolation, financial insecurity, burnout of the caregiver and anguish. Long-term COVID has been linked to fatigue, sleep disturbances, depression, anxiety, cognitive impairment, and post-traumatic stress disorder, or PTSD, among other conditions.
"Depression is the most prominent symptom that we see," said Dr. Jordan Anderson, a neuropsychiatrist and assistant professor in the department of psychiatry and neurology at Oregon Health and Science University, in Portland.
Diagnosing depression in someone with long-term COVID requires a nuanced approach than diagnosing this illness in the general population, Anderson said. This is because symptoms often associated with depression – such as disturbed sleep, fatigue, changes in appetite and concentration – are also associated with long-term COVID.
These symptoms alone "may not truly reflect a person's degree of depression," the doctor said. Instead, he looks for signs that the person no longer derives pleasure from things that used to be pleasurable and might still be enjoyed. He also asks about feelings of hopelessness or suicidal thoughts.
Dr. Anna Dickerman, chief of consultation and liaison psychiatry and associate professor of clinical psychiatry at New York-Presbyterian Hospital/Weill Cornell Medicine in New York City, said rates of depression and anxiety in people with COVID seems to be higher than in the general population, just as it is in people with other chronic diseases.
The virus that causes COVID-19 can contribute to a person's mental state in a number of ways, she said. The person may face prolonged isolation or may have to deal with physical limitations directly related to the disease, such as feeling easily exhausted and unable to function normally. Such limitations may even have resulted in her loss of employment.
"That can affect a person's day-to-day existence," Dickerman said. "If the person has low energy, they may want to lie down all day. But doing just that can make the person feel even more depressed."
Anderson said about half of the long-term COVID patients he sees at his clinic are suicidal. "I ask very specific questions," he said, including whether the thoughts started after they contracted COVID or happened before.
Anderson said that he believes there are two possible explanations for the high rate of suicidal thoughts.
“On the one hand, it is logical to deduce that living with a chronic disease that limits a person's capacity to such an extent and for so long – and at the same time causes stigmatization from family and others – would be demoralizing. Perhaps that is the most common explanation that my patients tell me," he said.
But some studies indicate that COVID can directly affect the brain. That makes us wonder, Anderson said, “If it's getting into the brain, is it affecting the parts of the brain involved in mood? We don't have that answer yet."
People living with additional stressors due to other social determinants of health -- such as discrimination, low income, limited access to health care and other resources -- may face even higher rates of depression, Dickerman said.
"If you have a higher level of stress in general, if you have low social supports, all of these things are going to affect you adversely," she said.
In addition to depression, Anderson said he sees a lot of anxiety, panic attacks and PTSD in the long-term COVID patients he sees.
PTSD, or PTSD, occurs in patients who have had near-death experiences or hospitalizations from their COVID infections, and in those who have lost loved ones to the virus and they may have feelings of guilt as survivors, Anderson said.
“Suffering from the long-term effects of COVID is itself a prolonged trauma that occurs over a period of many months. A person could be affected by anything disabling or due to any indication that they might get sick again, even if it is just a common cold. It's a terrifying feeling they have that they're going to get worse again or have a life-threatening experience again."
Other long-term COVID symptoms, such as heart palpitations, can be mistaken for panic attacks, he said.
"The person's heart rate increases dramatically indiscriminately and without any provocation," he said. "That alone can be very unsettling and can be mistaken for or lead to a panic attack."
When this happens, the person might be treated with an antidepressant when what they really need is medication to control the heart rhythm, or a referral to a cardiologist, Anderson said.
There is no standardized treatment for long-term COVID-related mental health issues, Anderson said. Treatment may include medication or talk therapy or both, depending on the person's symptoms. Group therapy can be helpful for people who need validation of their illness from others who are going through a similar experience. "When people feel like they're living in a community, that's worth its weight in gold," he said.
Dickerman said that in addition to medication and psychotherapy, there are several helpful techniques for anxiety that include meditation, relaxation and breathing exercises, along with graded physical activity tailored to the person's abilities.
"It's all about exercising in a way that's tolerable and gradual," she said.
If you or someone you know needs immediate help with a crisis, contact the national mental health hotline. Text 988 to speak with mental health and suicide prevention counselors in Spanish. The 988 Suicide and Crisis Prevention Line website has an option for "chats" in Spanish.
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