Understanding the link between long-term COVID-19 and mental health

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(Pirli/iStock via Getty Images)

Researchers have long understood that people with chronic health conditions, such as heart disease, are at increased risk of depression. The same may be true for people with COVID-19 symptoms that last for months or even years.

According to the latest U.S. Census Bureau data, an estimated 28% of U.S. adults with acute COVID-19 say they have experienced prolonged COVID-19 at some point. Prolonged COVID-19 occurs when a series of symptoms persist after the initial illness. It is more prevalent among the elderly, women, hospitalized and unvaccinated people. Symptoms vary but include fatigue, foggy head, dizziness, bowel problems, heart palpitations, sexual problems, changes in sense of smell and taste, thirst, chronic cough, chest pain, muscle cramps, and physical symptoms of any kind. or exacerbation of symptoms after mental exercise. .

The U.S. Department of Health and Human Services said in June that prolonged COVID-19 would have a “devastating impact on the mental health of those infected and their families” due to the illness itself, social isolation, and economic insecurity. warned of the possibility. , caregiver burnout and grief. It is thought to be associated with symptoms such as fatigue, sleep disturbances, depression, anxiety, cognitive impairment, and post-traumatic stress disorder.

“Depression is the most prominent symptom we see,” says neuropsychiatrist Dr. Jordan Anderson, assistant professor of neuropsychiatry at the Oregon Health and Science University in Portland.

Anderson said diagnosing depression in long-term COVID-19 sufferers requires a more nuanced approach than diagnosing depression in the general population. That’s because symptoms commonly associated with depression, such as sleep disturbances, fatigue, and changes in appetite and concentration, are also associated with long-term COVID-19.

These symptoms alone “may not accurately reflect a person’s depression,” he said. Instead, he looks for signs that a person is taking less pleasure from things they used to enjoy and can still enjoy. He also asks about feelings of hopelessness and suicidal thoughts.

Anna Dickerman, Ph.D., Chief Consultation Liaison Psychiatry and Associate Professor of Clinical Psychiatry at New York Presbyterian Hospital at Weill Cornell Medical College in New York City, notes that depression and anxiety in people with longer COVID-19 illnesses said the percentage appeared to be higher than those who had COVID-19. The general public, as well as people with other chronic diseases.

The virus that causes COVID-19 can affect people’s mental states in many ways, she said. The person may be experiencing prolonged isolation or face physical limitations directly related to the illness, such as being easily tired and unable to function normally. Such restrictions may have even cost them their jobs.

“It can affect everyday life,” says Dickerman. “People with low energy may want to stay in bed all day, but that can make them feel even more depressed.”

Anderson said about half of the long-term COVID-19 patients he sees at his clinic have suicidal thoughts. “The questions I ask are very specific,” he said, noting that the thoughts included whether the thoughts started after the coronavirus or had been there before.

Anderson said he believes there are two potential explanations for the high rate of suicidal thoughts.

“On the one hand, one can intuitively think that having a chronic illness, severely limiting one’s abilities for such a long period of time, and causing prejudice from one’s family and others, would be demoralizing. That’s the most common description I’ve gotten from my agents, patients,” he said.

However, some research suggests that the new coronavirus may directly affect the brain. This raises the question, “If it’s invading the brain, is it affecting the parts of the brain that control mood? We don’t know the answers yet,” Anderson said. .

People with additional stressors from social determinants of health, such as discrimination, low income, and limited access to health care and other resources, may experience higher levels of depression, Dickerman said. Ta.

“If you have more stress in general, if you have less social support, all of this will affect you negatively,” she said.

In addition to depression, Anderson said he sees a lot of anxiety, panic attacks and PTSD in long-term COVID-19 patients he treats.

PTSD occurs in patients who have had near-death experiences or hospitalizations related to COVID-19, or who have lost loved ones to the virus and may be experiencing survivor guilt, Anderson said. Ta.

“The prolongation of COVID-19 itself is a long-term trauma that occurs over many months. It can be triggered by certain symptoms, and it will get worse or lead to another life-threatening experience.”

Other long-lasting COVID-19 symptoms, such as heart palpitations, can be confused with panic attacks, he said.

“A person’s heart rate increases randomly and greatly without any trigger,” he said. “It can be very disturbing in and of itself and can be confused with or lead to a panic attack.”

In that case, Anderson said, they could be treated with antidepressants, even though what they really need is a heart rate-controlling drug or a referral to a cardiologist.

Anderson said there is no standardized treatment for long-term coronavirus-related mental health problems. Treatment may include medication, psychotherapy, or both, depending on the individual’s symptoms. Group therapy can help people who need proof of their illness from others who are going through a similar experience. “When people feel they have a community, it’s worth the gold,” he says.

In addition to medication and psychotherapy, Dickerman said techniques that can help with anxiety include meditation, relaxation, breathing exercises, and graded physical activity tailored to a person’s abilities.

“Increase the amount of exercise that you can tolerate,” she said.

A National Mental Health Crisis Line will be opened in July 2022 for those in urgent need of help. People can call or text 988 to talk to suicide prevention and mental health counselors.chat is 988 Suicide and Crisis Lifeline Website.You can also text message or chat available in spanish.

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