Longstanding COVID-related mental health issues require specialist treatment

Depression, anxiety, and other mental health issues frequently affect patients struggling with long COVID. Photo by Getty Images.

Even though the number of people hospitalized has dropped, many people are still facing a long COVID, defined by the CDC as symptoms that people experience four weeks or more after the original viral infection.

The “long haulers” of COVID face an array of challenges, including an invisible but no less formidable enemy: mental health burdens, in the form of anxiety, depression, mood disorders, post-traumatic stress disorder (PTSD) and more. These problems are often related to physical problems. Other symptoms may include chronic fatigue; shortness of breath; brain fog; and nerve, joint and muscle pain, to name a few.

These patients benefit from multidisciplinary care, which is available at the UCHealth Post-COVID Clinic. As part of an ongoing series on the long COVID and its treatments, UCHealth Today spoke with Dr. Thida Thant, assistant professor of psychiatry at the University of Colorado School of Medicine, and his colleague, senior instructor Dr. Heather Murray. Both provide mental health care to patients referred by the UCHealth Post-COVID Clinic.

Are medical and mental health issues sometimes linked in long-time COVID patients?

They are.

As Murray says, “The reality is that our brains don’t exist in a bubble. So if you have systemic inflammation issues or viral syndromes that affect other organs, it makes sense that they also affect the brain and cause other psychological symptoms. This is unfortunately something that patients with chronic fatigue syndrome and fibromyalgiafor example, have known for years.

A photo of Thida Thant
Dr Thida Thant

The interconnection of medical and mental health issues highlights the importance of post-COVID clinic, Murray added. “Patients may have shortness of breath, tachycardia [irregular heart rhythms] or brain fog without a lot of abnormal lab changes, she said.

Can long COVID exacerbate existing mental health symptoms – and vice versa?

Yes. “The reality is that depression is very common, and many people with COVID have a history of depression,” Murray said. “They’re going through a horrible time in their lives, let alone society going through a horrible time.” She noted a significant increase in the prevalence of depressive symptoms reported since the start of the pandemic – possibly up to threefold.

Where do you provide mental health care for long-term COVID patients?

The center is the psychiatric clinic for the medical complex, which predates the pandemic and is housed in the UCHealth outpatient psychiatric clinic. Thant is the director and Murray is the attending physician. “We’ve been seeing COVID patients for a long time since the summer of 2020,” Murray said.

How is the clinic helping patients with long COVID mental health symptoms?

To start, Murray said, “We do a comprehensive psychological assessment, as well as more specific psychological or cognitive screenings.” Assessments and screenings help identify symptoms such as depression, anxiety, PTSD, insomnia, fatigue, short-term memory deficits, brain fog – aka “COVID brain” – and mental health issues. attention and process,” Murray added.

Explain how this information is useful for those recovering from COVID-19

Murray said gathering in-depth psychological and cognitive information helps the team determine if there’s something more at play in a patient who has long COVID symptoms.

“There could be an underlying personality disorder or major depressive disorder that could inform the cognitive symptoms of COVID or make them worse,” she said. “Obviously the last year and a half has been a very difficult time for people. We’re trying to see if there’s anything happening that can be addressed to help them have a better quality of life.

What are some of the mental health treatments you offer?

In addition to providing individual psychotherapy and assistance with techniques like cognitive behavioral therapy, the clinic runs post-COVID survivor groups, one specifically for patients who were in intensive care units and another for all the other patients struggling with long-term symptoms, Thant said.

Dr. Heather Murray
Dr. Heather Murray

The clinic also partners with speech-language pathologists who provide cognitive rehabilitation and help patients struggling with attention, concentration, short-term memory loss and other cognitive issues to “retrain their brains”, added Thant. Drugs like Wellbutrin, an antidepressant, can also help boost focus and energy in patients dealing with these issues, she said, while other drugs treat mood, anxiety, mood sleep and other symptoms.

What have been the most daunting mental health challenges for long COVID patients?

“What we’re learning is that a lot of people deal with it as a chronic condition,” Murray said. “It’s not something they recover from in a few days. We learn from the shared experience of being a COVID patient how difficult it is to manage it on a day-to-day basis.

This experience often leads patients to doubt others, Thant added. “Because there are a lot of things that we don’t understand, there are people who are asking those who have these symptoms about the veracity of all of this and all that is going on in their head,” he said. she stated. “There is also frustration with the lack of treatment options.”

How do these frustrations with long mental health symptoms of COVID manifest in everyday life?

Brain fog, or COVID brain, which exacerbates previously mentioned problems with concentration and concentration, is likely the “biggest symptom” reported by longtime COVID patients, Murray said. “It’s really detrimental in everyday life, especially when people are trying to get back to work at the levels they were before. We have patients who are cognitively exhausted. They can’t do the whole day’s work that they used to do.

Some patients suffer from insomnia related to PTSD and medical trauma they suffered during COVID treatment, Thant added. “They come in saying they’ve had nightmares or weird dreams and they’re afraid to fall asleep.”

The long COVID can also make people reluctant to resume the lives they had led, Thant noted. “People can be afraid of being around other people with COVID,” she said. “They are afraid of reinfection, as well as resurgences and recurring lockdowns.”

Group sessions can help soothe this discomfort, Thant said. “As a group, you meet other people who understand your experience and are on this journey with you,” she said. “People identify this as one of the most useful things we offer – being able to share the fear of the unknown together.”

Are there resources that long-time COVID patients can use to self-manage symptoms?

Yes. Dr Melanie Dae, a senior psychology instructor at CU, recommends several apps to help with sleep and relaxation techniques. Some examples:

Exercise can also help, but Thant warned people to carefully manage their activity levels. “You don’t want to avoid activities like exercise because it helps eventually, but it’s better to take a more gradual/stepped approach to getting back to activities you might find exhausting post-COVID,” he said. she declared.

Patients can also help themselves by recognizing that there is no shame in seeking help for their mental health issues, just as they would for a medical condition such as high blood pressure, Murray added.

“There are certain things in your life that are happening and you need help,” she said. “You can spend time with your family, you can try to sleep better, you can exercise. But some of us have really stressful lives that we can’t change at the moment. If we have symptoms of this, there is no problem getting that extra support, just like you would if you had diabetes that you are doing everything you can to keep it under control. There’s nothing wrong with that.”

What is the state of psychiatric/mental health care for long-term COVID patients today?

“There is still a shortage of care,” Thant said. “There are only a few places in Colorado that offer it. That, combined with the increased mental health burden due to the pandemic and the waiting list for psychiatric care in general, has made the very difficult task for our patients.

Is there a “typical” long COVID patient you care for?

“We’ve seen patients from across the disease spectrum,” Thant said. “We did not find a 100% correlation between COVID disease severity and long-term symptom severity. We see patients who have not even been medically admitted to the hospital.

After two years of COVID-19, what insights have we gained about the long COVID?

“There seems to be a big inflammatory component to what happens that often leads to long-term symptoms,” Murray said. “I think it’s important to figure out who’s at risk and what some of the possible treatments are. Some patients progress steadily to improvement within weeks or months. Other people have a real experience of up and down, up and down. They get better, then get sick again or overwork and regress. There appear to be pathophysiological factors that produce symptoms that mimic depression. »

For more information on post-COVID mental health issues and resources for patients and providers, see the Department of Psychiatry website “Taking the brain into account: mental health in the time of COVID-19.”


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