LONG COVID AND DEPRESSION
Date: 03/22/24
Long Coronavirus Disease (Long COVID) is also known as Post COVID, Long Haul COVID, Chronic COVID, or Post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (PASC SARS-CoV-2). The majority of COVID patients recover from their symptoms, but some have symptoms for weeks, and in fewer cases symptoms persist for months and years after the COVID infection.1
The United Stated Department of Health and Human Services issued an advisory regarding the effects of Long COVID and mental health to help raise awareness amongst primary care physicians to aid in increased treatment for patients.2 The mental health conditions experienced include depression, anxiety, post-traumatic stress disorder (PTSD), psychosis, insomnia, and cognitive impairment (Table 1). Depression is the most prominent symptom seen.1,3
Table 1. Long COVID symptoms (List in not all inclusive)
Body Part | Symptom |
|---|---|
Whole body | Fatigue |
Insomnia | |
Weakness | |
Brain | Cognitive impairment (brain fog) |
Headaches | |
Mood symptoms (depression, anxiety) | |
Ears | Tinnitus |
Mouth | Loss of smell/taste |
Pulmonary | Shortness of breath, cough |
Cardiovascular | Chest pain, arrythmias |
More research is emerging about the causes of Long COVID. The current hypotheses are,
- The SARS-Cov-2 particles were reactivated in the patient’s body.
- Overactive immune cells release inflammatory markers causing injury to organs and tissues.
- The COVID-19 infection may have caused the body to make autoantibodies attacking the person’s organs and tissues.
There are some groups with higher risk factors for developing Long COVID (Table 2). Other risk factors that seem to affect whether a patient will develop Long COVID are the variant of SARS-Cov-2, female sex, older age, and initial immune response.1,3
Table 2. Long COVID risk factors
Severe COVID-19 with hospitalization or ICU stay |
Underlying health conditions such as diabetes, asthma, autoimmune diseases, or obesity |
Non-vaccinated against COVID-19 |
Multi inflammatory syndrome (MIDS) either during or after COVID-19 infection |
To help identify patients, screen members for depression using the patient health questionnaire nine (PHQ-9). Non-pharmacological aids including cognitive behavioral therapy and meditation can also be helpful.
If warranted, antidepressants can be prescribed. Second-generation antidepressants such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors, (SNRIs) or norepinephrine/dopamine reuptake inhibitors (NDRIs) are recommended based upon a more favorable side effect profile compared to first-generation antidepressants. Meridian Preferred Drug List
Meridian preferred antidepressants
Description | Drug |
|---|---|
SSRI | Fluoxetine |
Paroxetine | |
Citalopram | |
Escitalopram | |
Sertraline | |
SNRI | Venlafaxine |
Duloxetine | |
NDRI | Buproprion SR/XL |
Other agents | Imipramine |
Trazodone | |
Clomipramine | |
Amitriptyline | |
Doxepin | |
Nortriptyline |
References
1. Long COVID. Accessed March 20, 2024.
2. HHS Issues Advisory on Mental Health Symptoms and Conditions Related to Long COVID. Accessed March 20, 2024.
3. Williams L. Understanding the link between long COVID and mental health conditions. Accessed March 20, 2024.