2023-09-11| R&D

Long COVID’s Mental Health Toll: Understanding the Challenges

by Sinead Huang
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Recent research sheds light on the concerning connection between long COVID-19 and mental health, highlighting the need for comprehensive care for those facing persistent symptoms. As experts dig deeper into this issue, the impact on individuals and the healthcare system becomes increasingly apparent.

Related article: U.S. Government Awards $1.4 Billion to Advance COVID Therapies and Vaccines

The Prevalence of Long COVID

Long before the emergence of the COVID-19 pandemic, researchers understood that individuals with chronic health conditions, such as heart disease, had an elevated risk of developing depression. Now, it appears that individuals experiencing symptoms of long COVID may face a similar risk.

According to the latest survey data from the U.S. Census Bureau, an estimated 28% of U.S. adults at some point after acute COVID-19 infection reported experiencing long COVID symptoms. Long COVID refers to a series of symptoms that persist beyond the initial illness, affecting individuals differently. These symptoms may include fatigue, brain fog, dizziness, gastrointestinal problems, palpitations, sexual issues, altered sense of smell or taste, thirst, chronic cough, chest pain, muscle twitching, and symptom exacerbation following any form of physical or mental exertion.

Long COVID is more prevalent among older individuals, women, those who were hospitalized, and those who remain unvaccinated. 

The Mental Health Consequences of Long COVID

In June, the U.S. Department of Health and Human Services issued a warning that long COVID could have a “devastating impact” on the mental health of those affected and their families. This impact results from a combination of factors, including the disease itself, social isolation, economic insecurity, caregiver fatigue, and grief. It has been associated with conditions such as fatigue, sleep disturbances, depression, anxiety disorders, cognitive impairment, and post-traumatic stress disorder.

Dr. Jordan Anderson, a psychiatrist and Assistant Professor at the Oregon Health and Science University, points out that depression is among the most prominent symptoms observed in long COVID patients. However, diagnosing depression in these individuals requires a nuanced approach. Common symptoms typically associated with depression, such as sleep disturbances, fatigue, changes in appetite, and attentional shifts, are also related to long COVID.

Dr. Anderson emphasizes that these symptoms by themselves “may not truly reflect the severity of someone’s depression.” Instead, he looks for whether a person no longer finds pleasure in things they used to enjoy, whether they can still experience enjoyment, and inquires about feelings of hopelessness or suicidal thoughts.

Dr. Anna Dickman, Clinical Director of Psychiatry and Associate Professor of Clinical Psychiatry at New York-Presbyterian Hospital/Weill Cornell Medicine, notes that rates of depression and anxiety disorders appear to be higher among long COVID patients, similar to individuals with other chronic diseases. 

The virus responsible for COVID-19 can affect an individual’s mental state in various ways. Prolonged isolation, dealing with physical limitations directly related to their illness (such as fatigue and impaired functioning), or even the loss of employment due to these limitations are some of the factors that may contribute to depression and anxiety.

Addressing Mental Health Challenges in Long COVID Patients

Dr. Anderson reveals that approximately half of his long COVID patients report suicidal thoughts. He emphasizes the importance of asking specific questions, like whether these thoughts began after the COVID infection or were pre-existing.

The reasons for such a high rate of suicidal thoughts can be multifaceted. On one hand, it is intuitive to assume that living with a chronic illness that significantly impairs one’s ability, often for an extended period, and potentially experiencing stigmatization from family and others can lead to despair. This is the most common explanation he hears from patients.

However, some studies suggest that the virus itself may directly impact the brain. This raises questions like, “If it enters the brain, could it affect the parts of the brain responsible for emotions? We don’t have answers to this,” says Dr. Anderson.

Stressors related to social determinants of health, such as discrimination, lower income, limited access to healthcare, and other resources, may also contribute to a higher incidence of depression, according to Dr. Dickman. She highlights that greater overall stress and reduced social support can have a negative impact on mental health.

As of now, there is no standardized treatment approach for mental health issues associated with long COVID. Treatment may vary depending on individual symptoms and can include a combination of medication and psychotherapy, or a combination of both. Group therapy can also provide valuable support for individuals seeking recognition of their illness from others who have had similar experiences.

Dr. Dickman suggests that in addition to medication and psychotherapy, useful techniques for managing anxiety include meditation, relaxation, and breathing exercises, along with graded physical activities tailored to an individual’s capabilities. She advises, “Exercise in a tolerable and gradual manner.”

As researchers continue to explore the complexities of long COVID and its impact on mental health, there is a growing recognition of the need for comprehensive and tailored care for individuals experiencing persistent symptoms. Understanding these challenges and providing support is crucial to help those affected by the long-term consequences of COVID-19.

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