Could COVID-19 infection be responsible for your depressed mood or anxiety?

By: Stephanie Collier, MD, MPH, Contributor

Editor’s note: As information about COVID-19 continues to evolve, advice about protective measures changes. Please check the CDC web site for current information or talk to your doctor. Recommendations may vary depending on your community, whether you have underlying illnesses, and whether you’ve been vaccinated.

Doctors told you that your COVID-19 virus infection cleared months ago. However, even though you no longer struggle to breathe, and your oxygen levels have returned to normal, something doesn’t feel right. In addition to constant headaches, you find yourself struggling with seemingly easy tasks. The fatigue you experience makes moving from the bed to the kitchen feel like an accomplishment. But most troubling for you is a feeling of dread, a nervousness so severe you can feel your heart pounding. Constant worries now keep you from sleeping at night.

What are the mental health effects of COVID-19?

We are still learning about the long-term effects of COVID-19 on the brain. Data from Wuhan suggest that the virus may invade the brain, with more than one-third of infected patients developing neurologic symptoms. In addition to brain infection, we know that the pandemic has resulted in worsening mental health outcomes due to the psychological toll of isolation, loneliness, unemployment, financial stressors, and the loss of loved ones. The prescription of antidepressants has spiked, intimate partner violencehas increased, and suicidal thoughts are on the rise, especially in young adults.

Does COVID-19 infection increase the risk of psychiatric disorders?

Until recently, mental health outcomes as a result of COVID-19 infection were not known. A new study of electronic health records of 69 million people found that COVID-19 infection increased the risk of developing a psychiatric disorder, dementia, or insomnia. Furthermore, people with psychiatric disorders were 65% more likely to be diagnosed with COVID-19, which may be related to behavioral factors, lifestyle factors (such as smoking), inflammation, or psychiatric medication. This is the first large study to show that infection with COVID-19 indeed increases the risk of developing psychiatric disorders.

The long-term mental health effects of COVID-19 infection remain to be seen. Following the influenza pandemic of 1918–19, offspring of mothers infected during pregnancy were found to have higher rates of schizophrenia. It is thought that virus infection during pregnancy may be one risk factor for the development of mental illness related to the body’s immune response. If COVID-19 infection even slightly increases the risk of mental illness in offspring, this could have a large effect at the population level, given the high numbers of infections worldwide.

Do you have a psychiatric disorder as a result of COVID-19?

You may feel fatigued, stressed, or sad due to the effects of COVID-19 on your body, or due to life circumstances. However, even if you screen positive for depression or anxiety at your doctor’s visit, remember that screening tools are not diagnostic. People with physical symptoms of COVID-19 infection often screen positive for depression, as symptoms of infection often overlap with symptoms of depression. For example, poor sleep, impaired concentration, and reduced appetite may be due to a medical illness rather than depression.

For a doctor to make an accurate diagnosis, you may need to wait a period of time to monitor symptom development. Although antidepressants are often prescribed for mood and anxiety disorders, keep in mind that mild to moderate symptoms often go away on their own when life circumstances improve. If this is your first episode of depression or your first experience of anxiety, you may not require specialist treatment if your symptoms are mild. If you do start a medication, make sure to regularly review your treatment with your doctor and make changes as needed.

What steps can you take to minimize the mental health consequences of COVID-19 infection?

• Get vaccinated. This is especially important for people with psychiatric disorders, which are independent risk factors for COVID-19 infection.
• Continue to wear a mask and physically distance. However, aim to maintain social connections.
• Make use of resources. Online therapies, workbooks, and mobile applications (COVID coach, CBT-I coach) can provide benefits without risking exposure during treatment.
• Advocate for others. COVID-19 long haulers may not be in the position to advocate for workplace modifications, life insurance, or mental health coverage, especially if suffering from fatigue and brain fog.
• Perform physical activity. in addition to being as effective as medications on mood and anxiety, physical activity also helps with memory and heart health.
• Make use of relaxing rituals. When the world seems out of control, try establishing a ritual. Having control over even one part of your day can help you feel grounded.
• Use caution with sleep aids and as-needed medications. Short-term use can quickly become long-term use, leading to medication tolerance, dependence, and rebound anxiety.
• Limit alcohol and cannabis use. Prolonged stress from caring for sick loved ones, unemployment, increased time at home, and relationship stressors can result in increased and problematic substance use.
• Be mindful of caffeine. If post-COVID fatigue is severe, discuss other options with your doctor, as excess caffeine can exacerbate anxiety and sleep problems.
• Check in and ask how you can help your loved ones, friends, colleagues, and neighbors. It is often much easier to turn down help than to ask for help. If someone is privately struggling with thoughts of suicide, a simple check-in call or kind gesture can be lifesaving. The National Suicide Prevention Lifeline (800-273-8255) is available to anyone in severe distress.