What is the impact of long COVID on our mental health?

Mental health practitioners have for some time suspected a link between COVID-19 and the development of mental health problems. Emerging research affirms this, explains Dr Marshinee Naidoo, a specialist psychiatrist practicing at the Akeso Clinics in Parktown and Alberton.

She adds, "In an article published in August last year Elizabeth Cooney writes 'Long after the fire of a COVID-19 infection, mental and neurological effects can still smoulder. Early on, patients with both mild and severe COVID-19 say they can't breathe. After recovering from the infection, some of them say they can't think.' I find these words quite profound as the impact of the pandemic on mental health has been quite astonishing - in fact, during this pandemic, psychiatry has been at its busiest."

What is long COVID?

Long COVID refers to a range of symptoms that can last for weeks or months after the person was infected with the coronavirus. Experts also call it PASC, which stands for post-acute sequelae of COVID symptoms. The CDC says that long COVID can happen to anyone who has had COVID-19, even if you didn't have any symptoms or only had a mild illness when you had the infection.

Read more on the debilitating physical and psychological or emotional symptoms of long COVID that can severely impact your daily life.

Impact of COVID-19 on mental health

There's no doubt that mental health disorders are on the rise, says Dr Naidoo. "A study published in the Lancet in November 2020 showed that people who contracted the virus and who were well or had no previous psychiatric disorder, had double the risk of developing a mental health condition after the infection. These conditions include depression, anxiety and dementia, all of which have become quite common today.

The pandemic has brought up all sorts of traumas resulting in an increase of anxiety disorders, including post-traumatic stress disorder (PTSD). Fear, worry and stress are normal responses to perceived or real threats at times when we are faced with uncertainty or the unknown. So it's quite understandable that people are experiencing fear in the context of the COVID-19 pandemic. I've seen patients who have been stable on medication for some time, relapsing or re-emerging with their mental health condition after contracting COVID-19 - most of the time with minimal medical complications.

I've had patients who were well enough to have been weaned off their depression medication pre-COVID - with no other stressor other than the pandemic - needing to go back onto it. Fear of the pandemic is leading to more paranoia in patients with psychotic disorders, such as schizophrenia, even without them contracting the virus. And in the event of them testing positive, the impact on their mental health is quite significantly more severe.

And the biggest issue with all of this is that treatment is much more difficult. For example, when it comes to depression and anxiety, a patient's usual antidepressant or anti-anxiety medication - even at a higher dose - is not giving the same results."

Could long COVID involve immune-mediated depression?

Immune-mediated depression refers to depression that is caused by a person's immune system response (inflammation). Dr Naidoo says: "Researchers are still trying to establish exactly how the virus may impact the mind and the functioning of the brain. There's growing evidence of an increased risk of developing immune-mediated depression and this refers to the relationship between the immune system and depression - specifically inflammation. When the brain becomes inflamed, there's swelling that leads to specific psychiatric conditions. She adds, "According to one study, the level of inflammation is far higher in cases of autoimmune diseases and infection, resulting in an increased rate of depression that's often far more resistant to conventional antidepressant medication."

Dr Naidoo continues, "The most recent literature has shown an undeniable relationship between the activity of the immune system and neurological changes, along with subsequent psychological symptoms. The study explains that one of the main focuses of this field is the role of the immune system in mental health and psychological disorders, with emerging new evidence on the role of depression and fatigue in immune-mediated disorders".

Early intervention is essential

"It also reports that higher rates of depression and fatigue have been shown across a broad range of conditions associated with activation of the immune system, such as allergies, autoimmune diseases (type 1 diabetes, multiple sclerosis, systemic lupus erythematosus and rheumatoid arthritis) as well as infection," says Dr Naidoo. She adds, "And while further research into the relationship between the immune and psychological systems is essential, immune-mediated depression in patients with long COVID is becoming increasingly apparent these days.

We're already seeing that depression and anxiety in long COVID patients are often far more difficult to treat with the usual treatment regimes, so the sooner the intervention the better." She concludes, "That's why it's so important to seek professional help as soon as possible for any persistent mental health symptoms that are either of concern to you, or to the people around you."

Read more on this theme by exploring Dr Naidoo's insights into the importance of seeking professional help when dealing with the mental health effects of long COVID.