“If I could take one symptom away from all of [my long-COVID patients], I think that would be depression,” said critical care specialist Dr. Joseph Varon, chief of critical care and the COVID-19 department at the United Memorial Medical Center in Houston, Texas.

Beyond the physical tribulations and social instability that this condition can bring, long-COVID patients feel that the one thing not getting adequately addressed is the mental health toll the disease inflicts.

One thing Varon has observed in his long-COVID patients is that, though everyone is affected differently, they are all depressed and anxious as a result of the disease. 

The long-COVID symptoms and physical deterioration are major contributors. Cognitive impairments—colloquially known as brain fog, fatigue, malaise, and debilitation—can impact a person’s employment and social well-being, further leading to mental health problems.

“They get so concerned that their cognitive functions are not [at their] best, and that they have sleep difficulties,” Varon said.

For people who have been suffering for a long time, the hopeless thoughts that they may never recover and return to normal life are the most crippling.

Psychiatrist Dr. Adonis Sfera relayed a story about his friend, who is a surgeon in his 30s. Since contracting long COVID, he has not been able to work for two years. “He told me that walking makes him very tired and [he] feels depressed, thinking that he may never recover enough to be ‘like before,’” Sfera wrote in an email to The Epoch Times.

Hannah Camp Johnson, who developed long COVID in August 2020, had to give up on reading, which used to be one of her favorite hobbies, as she would forget the book’s content soon after reading it. Seeing a progressive worsening in her symptoms that is gradually spiraling out of control, Johnson said that she has been battling with bad thoughts of suicidality.

COVID-19 may also directly or indirectly interfere with the human brain.

“Some viral proteins can interact directly with human neural pathways involved in the processing of mood, sleep, or anxiety,” Sfera wrote in the email. The feelings of anxiety, depression, loneliness, or helplessness may also be due to the biological imbalance that the disease causes.

Interestingly, he stated that these COVID-19 findings further support the concept that “the distinction between the body and the mind is imagined, not real,” as viral infections, which are something biological, can also affect the mind.

He pointed to data on posttraumatic stress disorder (PTSD) rates. People who are infected with viruses such as SARS-CoV-2, human immunodeficiency virus (HIV) (pdf), and Ebola (pdf) were associated with PTSD rates of 30 percent or more, which is almost double the rate of 16 percent in military personnel and war veterans, who are likely to have trauma from experiences such as combat. Sfera interprets this to mean that, apart from the psychological stress causing the mental problems, the viruses may be impacting the brain and directly wreaking havoc on mood.

The SARS-CoV-2 virus may also contribute to premature aging and the breakdown of endothelial cells—the inner lining of all blood vessels. This would affect the blood supply to the local organs, and if the endothelial cells in the brain are affected, it can potentially cause cognitive and mood disturbance.

Sfera gave the example of tryptophan, which is an essential amino acid individuals obtain through the diet. The body uses tryptophan to make serotonin, a neurotransmitter that can regulate a person’s mood.

Making serotonin from tryptophan requires angiotensin-converting enzyme 2 (ACE2), which is a receptor that regulates and maintains blood pressure.

But since SARS-CoV-2 binds to ACE2 receptors to infect cells, COVID-19 infections can block and deplete ACE2 activity, in turn blocking tryptophan absorption and the formation of serotonin.

“This is sufficient to induce depression and anxiety, even in the absence of psychological stressors of being ill, isolated, hopeless, or in pain,” Sfera explained.

Tryptophan also activates a protein in the gut that regulates the composition of gut bacteria. When tryptophan is absent, this protein is not activated and can lead to diarrhea, inflammation, irritable bowel syndrome, and other gut-related symptoms.

However, this same protein is also involved in regulating circadian rhythm and sleep, which may explain the exacerbation of sleep and circadian dysfunction in long-COVID patients, Sfera added, as well as experiences of confusion or brain fog.

The possible biological imbalances from the damage of COVID-19 suggest that a restoration using antidepressants can help some patients both mentally and physically.

Early in the pandemic, an inexpensive antidepressant called fluvoxamine received a lot of media attention for its broad antiviral and anti-inflammatory abilities. Many studies suggested that fluvoxamine could be used in early treatment (pdf) to prevent COVID-19’s progression to severe disease and hospitalization. However, the U.S. Food and Drug Administration later published a statement asserting that there was insufficient evidence for the use of fluvoxamine in COVID-19 (pdf).

Nevertheless, Sfera has found the drug to be very helpful in acute COVID and long-COVID mental health symptoms. He speculates that the drug not only helps patients mentally, but also boosts their recovery from physical injuries.

The drug is approved to treat anxiety and depression as a selective serotonin reuptake inhibitor.

Studies have shown that fluvoxamine can also prevent inflammation, blood clots by preventing platelet aggregation, and severe allergic responses due to its inhibitory nature.

Other reports suggest the drug may be able to reduce inflammation in endothelial cells and therefore prevent their aging and deterioration. Fluvoxamine may also prevent neural death in the brain.

Beta-blockers, which are usually prescribed for high blood pressure, have also been suggested to help with symptoms of anxiety by blocking chemical messengers that activate the fight-or-flight response. They may also help regulate cognitive functions by resynchronizing the circadian rhythm, helping insomniac patients to get a more restful sleep.

It should be noted that with all medications, there are potential side effects. Fluvoxamine may induce mental changes such as increased irritability and depression, twitching, and constipation, as well as other potential side effects. Beta-blockers may cause a person to feel tired, or even cause problems with sleeping, including nightmares.

The biological and the mental work in a cycle. Just as biological changes impact the mind, the reverse can also happen where the mind acts on the physical. Therefore, when people are in a healthy headspace, they may see improvements both mentally and physically.

Varon said that among his recovered long-COVID patients, a common factor they shared was positive thinking and trusting that they would get better.

Psychiatrist Dr. Chloe Saunders, who is a doctoral candidate and researcher at Aarhus University, related this way of thinking to the placebo effect—a beneficial effect produced by a patient’s belief in the treatment rather than the drug or procedure itself.

Since human bodies have their own mechanism for repair and rejuvenation, Saunders said that it is very important for people to connect to and trust their body during recovery—trust that the body will “doctor itself.”

A trusting bond between a patient and their doctor can reap similar benefits for the patient.

Board-certified internist and nephrologist Dr. Richard Amerling told The Epoch Times that a good doctor would be able to make patients feel better “just by being present.”

When a patient perceives that a doctor is actually caring about them, “they actually start to improve physically [and] emotionally,” Amerling said.

A major difficulty for some patients is forming this trusting bond, and they may need assistance.

“It’s quite inaccessible for a lot of people,” Saunders said. “They’ve never been taught how to do it. Things like trauma, body image, or body dysphoria, get in the way of that as well.”

Mindful activities can help people to become grounded in their bodies. Saunders suggests meditation, yoga, being in the presence of nature, “forest bathing,” or even taking a walk.

When done in a relaxed and peaceful state, all of these practices have been shown to activate the parasympathetic system. Known as the “rest and digest” system colloquially, the parasympathetic system helps with repair and recovery.

Saunders advises mindful activities under the sunlight and also before bedtime, encouraging making these activities a daily routine. “The body needs this time to be in a relaxed state in the parasympathetic system,” she said.

The modern lifestyle takes the body out of its cycle of needing quality rest and rejuvenation. People work hard during the day and overstimulate with screen entertainment during times of rest, which means the body and mind are not getting a good break.

This is why for the many who have never practiced mindfulness, reconnecting to the body may seem foreign and even intimidating, but Saunders believes that with guidance, everyone can unlock great benefits from grounding within their body.

The establishment of trust in recovery also includes counseling, forming support groups, or breaking mental habits that may cause mental stress.

As with all things, moderation is very important regarding the amount of bonding with others, as well as sensitivity to the body’s changes.

Some patients may hyperfocus on certain symptoms, which can cause distress and may feed into a vicious cycle if the body does not recover as fast as intended. This does not mean that patients should be unaware of their symptoms, but studies show that patients’ failure to notice signs of recovery is correlated with poorer recovery.