Could COVID-19 trigger depression?

When Glo Lindenmuth was sick with COVID-19 in December 2021, she was congested and exhausted for about a week; her sense of smell and taste were gone for two weeks. These symptoms were not something she was surprised to discover. But the sadness and trouble sleeping that kicked in weeks after she recovered from COVID caught her off-guard.

“I had depression as a teenager, but this was much worse,” says Lindenmuth, 30, who works in corporate communications in New York City. She felt down and had trouble sleeping. Her brain was foggy and bleak when she was awake. She often thought about doing something to harm herself. She was extroverted and bubbly, but she was also overwhelmed by social anxiety. She says, “I would cancel plans with friends, go to bed at night, avoid most calls and texts, and cancel all social events.”

Her symptoms lasted more than two months.

In the spring, Lindenmuth felt a little better, but then she was hit with a severe depression that lasted from mid-June through mid-August. She saw a psychiatrist and was diagnosed with depression.

It’s estimated that millions of people are discovering that even after they think they have bounced back from their COVID-19 illness, they continue to feel down, fatigued, apathetic, anxious, or otherwise emotionally out of sorts.

In a study based on millions of people who used the U.S. Department of Veterans Affairs health system, “we noticed that we had a nation in distress, due to the mayhem of the pandemic and lockdown,” says Ziyad Al-Aly, director of the clinical epidemiology center at Washington University in St. Louis, Missouri, and a coauthor of the report. Al-Aly and his colleagues wanted to know whether people who got COVID-19 had a higher risk of mental health problems after symptoms of the illness subsided. “The answer was absolutely yes. People with COVID had it much, much worse. ”

According to research in the June 2022 issue of the journal CNS Drugs, 35 percent of people reported depressive symptoms after recovering from COVID. It could be that they have lost days or weeks of their normal lives due to COVID. It may be because they have a little-known phenomenon called post-viral depression, which is likely triggered by inflammatory changes, psychological stress, and other factors.

These symptoms typically “kick in two to three months after the onset of COVID-19 and seem to last several months,” says Madhukar Trivedi, a psychiatrist and founding director of the Center for Depression Research and Clinical Care at the UT Southwestern Medical Center in Dallas. “There’s no way to predict who will have transient effects or who will have persistent ones.”

The scope of the phenomenon

The link between viral illnesses and depression isn’t new but has become more widely recognized and understood in recent decades. A study in a 2016 issue of the journal Brain, Behavior, and Immunity, for example, found that people who were sick with the flu in the previous 30 to 180 days had a 57 percent higher risk of new onset depression, compared to those who dodged the virus. Post-viral depression also can happen with the Epstein-Barr virus, which causes mononucleosis, and other non-specific viruses, experts say.

Al-Aly’s study, published in February 2022 in BMJ, found that people who’d been sick with COVID had a 35 percent higher risk of developing an anxiety disorder and a 39 percent higher risk of experiencing a bout of depression a month after their illness; these surges were accompanied by increased use of antidepressants and benzodiazepines. This is not an isolated finding. A study in the April 2022 issue of the Journal of Neurology found that elevated levels of apathy and anxiety were common among COVID survivors who had fatigue eight months after their illness. And in a study in the May 2022 issue of The Lancet, researchers followed the mental-health trajectory of people in six countries in Europe who had been sick with COVID–but weren’t hospitalized for it–and found that these individuals had a higher prevalence of depression in the subsequent months, especially if they had been bedridden with the illness.

Mechanisms behind the misery

Exactly how COVID-19 triggers depression isn’t fully understood but there are several hypotheses. Al-Aly explains that the SARS-CoV-2 virus could cause more inflammation in brain and activate microglial cell immune cells in central nervous system, which produce inflammatory molecules. “Inflammation can affect brain regions that regulate affect and emotions–it can turn them up or turn them down.”

Another theory is that the virus can attack the lining of blood vessels, which can compromise the blood and oxygen supply to the brain and disrupt areas that regulate emotion, Al-Aly adds.

A third hypothesis suggests that the virus can disrupt the diversity and equilibrium of the bacteria in the gut–the gut microbiome–which could in turn alter the levels of certain neurotransmitters, chemical messengers that transmit nerve signals throughout the body and brain and are involved in mood regulation, he says. Al-Aly states that the virus’s impact on mental health is a biological phenomenon and cannot be imagined.

That’s not to say there aren’t psychological elements at play. Pravesh Sharma, a psychiatrist at Mayo Clinic College of Medicine and Sciences, Eau Claire, Wisconsin, suggests that prolonged isolation and feelings of loneliness may contribute to post COVID depression. Sharma states that post-COVID depression can lead to people asking “why me?” Sharma says that this can lead to a vicious circle that traps people in a depression state.

Compounding the problem, people with post-COVID depression often feel misunderstood. Dawn Potter, a Cleveland Clinic clinical psychologist, says that families often don’t understand why their loved ones aren’t over it. These “people don’t know when their symptoms will end or what’s going to help, so they are scared.” It’s not uncommon for people to fear getting COVID again. Experts also say that people worry about the long-term effects of COVID infection. This can lead to emotional turmoil.

Who’s vulnerable and why

While research on the issue is scarce because COVID-19 is still relatively new, experts believe that people who have a prior history of depression or anxiety are at higher risk of developing post-COVID depression. Potter says, “What I see in my clinical practice are people getting depression after COVID” or having it exacerbated by COVID if there was depression before. “It may have been in remission or less severe.”

Others who are at higher risk for post-COVID depression, experts say, include people who had high levels of pre-infection stress, medical morbidities–obesity, asthma, hypertension, diabetes, and the like–and more severe illness with COVID-19. In some cases, depression can be a part of long COVID syndrome. This can include persistent problems with memory, thinking abilities, concentration, mood changes, and organizational skills such as difficulty managing money or medication. Dyani Lewis, 44, experienced this phenomenon firsthand after getting COVID in March of 2022. Although she only had a mild case, Dyani Lewis 30 experienced this phenomenon firsthand after she was diagnosed with COVID in March of 10. She had been taking a selective serotonin reuptake inhibitor (SSRI) for depression since 2019 and her mood symptoms had been well-controlled–until suddenly they weren’t.

” I was having trouble completing my work and didn’t have the energy to care for my children,” said Lewis, a freelance science journalist living in Melbourne, Australia. “Whether SARS-CoV-2 directly contributed to my depression or created the conditions that made me feel like shit, is something I don’t know.” Lewis is currently switching to a new medication and has begun light exercise to improve her mood.

Experts say they’re not seeing clear gender patterns with post-COVID depression. But a study in the January 2022 issue of the Journal of Psychiatric Research found that among COVID-19 survivors in Italy who experienced psychiatric symptoms, men had high levels of anxiety and depression at six months and even more severe symptoms at 12 months; women experienced the worst depression shortly after the infection, but by six months the symptoms were much less serious and continued to decline until 12 months. Researchers speculated that men may have a stronger proinflammatory immune response than women, which could cause chronic inflammation in their brains after COVID infection. Another reason is that they are less likely to seek professional assistance for mental health issues.

Reclaiming a better state of mind

Although some cases of post-COVID depression will resolve naturally over time, there’s no reason to sit back and suffer in the meantime. “It’s important not to say this is due to COVID and therefore do nothing,” Trivedi says, “because it could last longer than you think.”

To feel better mentally and emotionally, it helps to engage in regular physical activity or exercise, which has anti-inflammatory properties as well as antidepressant effects, Trivedi says. Connect with family and friends to find support. And adopt healthy eating habits such as the Mediterranean diet–which is rich in fruits, vegetables, legumes, nuts, whole grains, fish, and olive oil–because research has found that it’s associated with a lower risk of developing depression. In addition, a study in a 2019 issue of the journal PLoS One found that a healthy dietary intervention can start to work in as little as three weeks, reducing symptoms of depression. It’s important to establish the right conditions for better sleep, because “sleep issues and depression go hand-in-hand–it’s an a bidirectional issue,” Potter states. Poor sleep can impact your mood and can lead to depression. She says, “If you can get to sleep better, it often helps your mood.” She suggests that you work on your sleep habits. Make a concerted effort in the morning to turn off the lights and avoid using digital screens at night. Get to bed and get up at the same time every day to maintain a consistent sleeping-wake cycle.

There’s no need to stop your feel-better efforts with lifestyle modifications. You may be able to benefit from therapy, especially cognitive behavioral therapy (CBT). This therapy helps people change their negative thought patterns and create more positive ones. Another approach is behavioral activation. This skill is often integrated into CBT. It involves setting goals that will help improve your mood. Jed Magen, an Osteopathic physician who specializes in child and adolescent psychoiatry at Michigan State University East Lansing, states that this skill can be very helpful. Lindenmuth began to feel better with the help of antidepressants and talk therapy. She also shared her experiences with her friends. Gradually, she started exercising more and discovered her passion for dancing, cooking, and spending time with her friends. She says, “Now I feel great and I have the energy that I used to.” Lindenmuth states that she has regained her creativity and a sense of clarity. “I’m happy to be on the other side of the worst of it.”

When it comes to experiencing post-COVID depression and obtaining relief from it, Lindenmuth is in good company. Potter states that post-COVID is a very common condition and that there is hope. “The research is showing that there is a way to treat it, just as there are for other types of depression.” “Even though it’s not completely understood, we’re not reinventing the wheel.”