Experts Link Long COVID with Depression and Multiple Mental Health Concerns

On May 11, 2023, the United States government ended the federal COVID-19 Public Health Emergency (PHE). Six days earlier, the World Health Organization (WHO) had concluded the global PHE. The official COVID emergency may be over, but patients with Long COVID report an adverse impact on their mental health.

In the first 15 days of the same month that these PHEs ended, WHO reported 1,011,174 new cases of COVID and 7,398 deaths. Clearly, the end of the official emergencies did not mean that the health threat was over.

Though new infections and additional deaths cause significant pain and suffering, additional COVID-related concerns have the attention of health experts in the U.S. and around the world.

As the end of the official global and federal PHEs approached, several reputable sources sounded the alarm about two ongoing problems related to the coronavirus: Long COVID and its impact on mental health.

What is Long COVID?

Officially named “post-acute sequelae of COVID-19” (or PASC), Long COVID is a general term for a wide range of new, continuing, or returning symptoms that a person experiences for more than four weeks after they were initially diagnosed with COVID.

Here’s how the Substance Abuse and Mental Health Services Administration (SAMHSA) described Long COVID in a January 2023 report:

The condition encompasses an array of approximately 200 different symptoms that are often variable, wide-ranging, and may relate to multiple organ systems, including respiratory, cardiovascular, musculoskeletal, gastrointestinal, neurological, psychological/psychiatric, and/or dermatologic.

The U.S. Centers for Disease Control and Prevention (CDC) has reported the following facts about Long COVID:

• Symptoms of Long COVID may persist for weeks, months, or even years.
• Anyone who contracted COVID may develop Long COVID, but the risk is highest among people who had particularly severe cases of the original disease.
• It is possible for a person to develop Long COVID without knowing that they had ever contracted COVID.
• Unvaccinated people who had COVID have a higher risk of developing Long COVID than do people who contracted the original disease after receiving the vaccine.
• Several of the most commonly reported symptoms of Long COVID include fatigue, respiratory problems, chest pain, abnormal heart rate, “brain fog” and other cognitive or neurological symptoms, diarrhea and stomach pain, rash, and disrupted menstruation.
• There is currently no test to diagnose Long COVID.

“The non-specific nature of symptoms and the lack of a consensus definition have made diagnostic efforts challenging,” SAMHSA noted in the January 2023 report referenced above.

The organization reported that as many as 30% of people who contracted COVID (or up to 23 million people) may have Long COVID, which SAMHSA described as “a significant and ongoing public health crisis.”

Long COVID and Mental Health Symptoms

Experts have long recognized the connection between physical health problems and mental health challenges. For example, serious injuries or illnesses can be risk factors for myriad mental health disorders, including anxiety, depression, and posttraumatic stress disorder (PTSD).

A December 2022 article on the website of the American Medical Association (AMA) indicated that the mental health impact of Long COVID may include both new disorders and returning (or resurgent) symptoms.

“Most of our patients don’t fit into one neat box,” former AMA President Patrice A. Harris, MD, MA, said in the December 2022 article.

• For some people, the combined physical and mental strain of an extended struggle with COVID symptoms can cause a person to develop symptoms of anxiety, depression, or other mental health concerns.
• For others, the ongoing effects of Long COVID can exacerbate symptoms of bipolar disorder, PTSD, or other conditions previously brought under control by medication and therapy.

Complicating the matter, the AMA article revealed, is that some people may attempt to deal with these effects by abusing alcohol or other drugs. Whether this represents a relapse or a person’s initial descent into substance abuse, this behavior can take a potentially bad situation and increase the likelihood that it may become much, much worse.

Long COVID and ‘Brain Fog’

Former AMA President Harris and the CDC are among many healthcare professionals and organizations that have used the term “brain fog” when discussing the potential mental health impact of Long COVID. Though this evocative term is not an official diagnosis, it has become a common way to describe one of the more prevalent set of COVID-related cognitive and neurological effects.

In February 2023, the AMA website focused on this topic in a public health article titled “What doctors wish patients knew about long COVID-19 brain fog.”

Key Points: Long COVID and Brain Fog

• Brain fog can involve myriad challenges, such as forgetfulness, confusion, slowed response times, and a diminished ability to focus or concentrate.
• Of the 2,359 adults with Long COVID who participated in a recent JAMA Open Network study, more than 45% said they were dealing with either memory problems or brain fog.
• The lack of either an official definition of brain fog or a test to diagnose it can cause greater distress among patients, as they fear being accused of inventing these symptoms or stigmatized for having them.
• As with Long COVID itself, brain fog seems to be more common among unvaccinated people and those who had more severe COVID symptoms.
• Many patients with brain fog also struggle with symptoms of anxiety and/or depression. This may be due not only to the direct impact of brain fog itself, but also the uncertainty about when (or if) the brain fog symptoms will begin to dissipate.

Since fog is a temporary weather condition that is rarely associated with significant damage, some people worry that the term brain fog may not adequately convey the seriousness of this problem.

In a May 2023 Scientific American article, a Long COVID sufferer who is identified only as Ken emphasized that his experience with brain fog is much more than a minor inconvenience.

“When I’m having a brain fog day, I have to ask my wife to bring me a stockpile of daily necessities in bed before she leaves for work,” Ken said. “I can’t stand up, I can’t move, and I can’t function for hours, even days sometimes.”

Long COVID and Mental Health

As suggested by Ken’s statement at the end of the previous section, the mental health impact of Long COVID can be both severe and extensive.

The association between Long COVID at serious psychological effects was also the focus of a cross-sectional study that appeared in the Journal of Neurology, Neurosurgery & Psychiatry in October 2022.

This study, conducted by a group of French researchers, looked at the prevalence of psychiatric health concerns among 177 patients admitted to intensive care due to COVID or with Long COVID symptoms four months after hospitalization.

According to the research team, this study represented the first effort to evaluate the link between Long COVID and psychiatric disorders diagnosed by qualified psychiatrists. Their findings included the following.

Long COVID and Psychiatric Disorders

• 20.3% of the COVID patients in the study had a psychiatric disorder. Of this group, 81% developed the disorder after COVID diagnosis.
• 13.6% of patients with COVID had episodes of major depressive disorder.
• 11.3% of the COVID patients were dealing with anxiety disorders.
• 3.9% of the patients who developed COVID had PTSD.
• 5.1% of the study’s subjects had a significant risk of suicide.

The team also reported that individuals who reported a higher number of COVID symptoms were more likely to also experience insomnia as well as symptoms of anxiety, depression, and PTSD.

When evaluating patients in terms of the specific COVID symptoms they developed, the researchers found that respiratory problems and cognitive problems (such as brain fog) had the strongest association with psychiatric disorders:

• The prevalence of psychiatric disorders was four times higher among patients whose Long COVID symptoms included respiratory problems.
• Long COVID patients who had cognitive difficulties were twice as likely to have a psychiatric disorder and seven times more likely to be at risk of suicide.

These findings, the research team wrote, should prompt both medical and clinical professionals to pay particular attention to the mental health of patients who have a history of especially severe or long-lasting symptoms of COVID.

“Long COVID complaints are associated with psychiatric disorders, new-onset psychiatric disorders, significant suicide risk and psychiatric symptoms,” the researchers concluded. “In patients with long COVID, especially those with respiratory or cognitive complaints, psychiatric disorders and suicide risk should be systematically assessed.”