Long COVID may worsen mental health disorders: experts
Amid the global COVID-19 pandemic, there has been growing concern about the persistence of symptoms in those who have passed the acute phase of infection, known as long COVID or PASC (Post-Acute Sequelae of SARS-CoV- 2). Although the focus has been on the long-term physical effects, it is crucial to recognize the significant impact that long COVID can have on the mental health of those affected.
Experts have made it clear that mental illness is not the cause of long COVID. However, post-pandemic stress and anxiety can worsen existing mental health conditions or cause new psychiatric symptoms in people with PASC.
The statement, published in the journal Physical Medicine and Rehabilitation of the American Academy of Physical Medicine and Rehabilitation (AAPM&R), offers valuable guidance for the evaluation and treatment of mental health symptoms in patients with PASC.
Developed by a multidisciplinary working group that includes experts in physical medicine, neurology, neuropsychiatry, neuropsychology, rehabilitation psychology, and primary care, this guide represents a comprehensive effort to address the complex challenges posed by long COVID.
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Physiatrist Abby Cheng, MD, co-author of the guideline, underscores the importance of recognizing the reality of long COVID and highlights that mental health conditions are not the underlying cause. Many patients have faced disbelief from loved ones and sometimes health professionals, who have minimized their symptoms by attributing them to mental problems.
Cheng emphasizes that long COVID is a genuine condition that deserves proper clinical care and that mental illnesses should not be stigmatized or misinterpreted as the cause of long-term symptoms.
Covid inflammation can worsen mental health symptoms
According to the guidance statement, anxiety and depression have been identified as the second and third most common symptoms of long COVID. This finding highlights the critical need to address not only the physical, but also the mental aspects of long-term recovery.
Cheng explains that the body’s inflammatory response, especially circulating cytokines, could contribute to worsening mental health symptoms or trigger new symptoms of anxiety or depression. In addition, the connection between the persistence of the virus in the body, blood clots and changes in the intestinal microbiome with mental health in patients with long COVID is being investigated.
The guidance emphasizes that mental health symptoms in patients with long COVID can mimic the physical symptoms of the disease, such as fatigue, brain fog, sleep disturbances, and tachycardia. Therefore, it is essential that health professionals take a comprehensive approach to treatment, recognizing the interrelationship between the physical and mental aspects of recovery.
The recommended treatment is the same for both those with long COVID and those with mental illness and includes management of coexisting medical conditions, supportive therapy, cognitive behavioral therapy, and pharmacological interventions.
Additionally, the guide offers clear guidelines for primary care professionals, suggesting that, where possible, they be the first line in addressing mental health symptoms. However, she also recognizes the need to refer patients to specialists when symptoms significantly interfere with their functioning and ability to interact with the community. This stratified approach ensures personalized and effective care for each patient.
Although a decrease in long COVID cases has been seen, the chair of rehabilitation medicine at UT Health San Antonio, Mónica Verduzco-Gutiérrez, MD, cautions that it remains a significant concern. The guidance highlights estimates from the Centers for Disease Control and Prevention, which indicate that about 7% of American adults and 1.3% of children have experienced long COVID.
