While many with COVID-19 have recovered from mild and asymptomatic cases in a few weeks, others have endured ongoing symptoms for months. This has become known as long COVID, a collection of physical and emotional COVID symptoms with uncertain long-term outcomes. Individuals who develop long COVID may contend with months of depression or PTSD symptoms and may also wonder how long their post-COVID anxiety will last.
Because the virus has only been observed for a few years, COVID’s long-term mental and physical effects are unclear. Understandably, individuals facing uncertainties about their health after recovering from COVID-19 may endure lingering depressive and anxiety symptoms.
Read on to learn about COVID-19 and how it can develop into long COVID. Then take a closer look at long COVID’s psychological symptoms, co-occurring mental health disorders, and treatment options.
COVID-19 is an infectious illness caused by the SARS Cov-2 virus, spreading worldwide as a pandemic since early 2020. 81% of individuals with COVID-19 develop mild to moderate respiratory symptoms, such as a cough, fever, fatigue, and loss of taste or smell. Unfortunately, up to 19% experience severe to critical symptoms, including difficulty breathing, persistent chest pain, and organ failure. It can be challenging to predict how individuals may respond to COVID-19 infection. Still, older adults and individuals with chronic health conditions were identified early in the pandemic as having a higher risk of developing severe symptoms and potentially death.
Long COVID is a condition where initial COVID-19 symptoms persist for months following an initial confirmed or suspected infection. Long-term symptoms may also emerge after an individual appears to have recovered. And long COVID can develop regardless of how severe an individual’s COVID illness is, including after asymptomatic cases.
Reports vary, but estimates indicate that anywhere from 31-69% of individuals with COVID-19 across the globe have persistent symptoms, which may improve and worsen periodically. This challenging condition significantly impacts quality of life, health outcomes, and work lives of millions of individuals.
Commonly Reported Long COVID Symptoms Include:
The exact mechanisms of long COVID are not well understood, but studies have shed some light on possible causes. One cause may be a result of the cell and organ damage caused by COVID-19. Another source of long-term COVID symptoms may be prolonged hospitalization, a stressful experience with its own set of consequences. Cognitive impairment, muscle weakness, and psychosocial stress can develop following long periods of time in the intensive care unit (ICU). As these ICU-related symptoms overlap with COVID recovery, symptoms may take longer to diminish. A third potential cause of long COVID may explain long COVID symptoms after recovery. Symptoms such as loss of smell, insomnia, or lingering headaches may be easily dismissed or misunderstood, adding more distress. Every individual’s immune system interacts with inflammation in unique ways, making lingering symptoms challenging to treat.
As the number of individuals contending with long COVID symptoms continues to grow, one question remains—why do some develop long COVID while others do not? The answer is unclear, but researchers have identified common characteristics of individuals at higher risk.
Potential Risk Factors for Long COVID Include:
For those who develop long COVID, emotional symptoms are often observed. And mental health disorders occurring with COVID-19 are among the many potential consequences of contracting the illness. Having a pre-existing mental health disorder may also be an independent risk factor for developing COVID-19.
A more severe course of COVID-19 has been associated with a greater chance of developing depression, with the risk emerging in two ways. Low-grade inflammation has been suggested as a possible link between depression and COVID-19, often resulting in impaired cognitive functioning and lower quality of life. Another study indicated that being bedridden for seven days or more during recovery was linked with a 50-60% greater risk of developing depression. Interestingly, those who recovered quickly from a mild infection and returned to their regular life with fewer restrictions were at an even lower risk for depression than non-infected individuals.
The prevalence of persistent anxiety symptoms following the acute stage of COVID-19 is high. One study reported that anxiety symptoms were disruptive enough to impair functioning or cause significant distress for 35.6% of individuals three months after initial COVID-19 symptoms developed and for 34.7% at the six-month mark. A lack of understanding about the COVID-19 pandemic and less family support may be related to an increased risk of long COVID anxiety. Understandably, the lack of clear information in the early stages of the pandemic likely contributed to ongoing anxiety. While the scope of the pandemic itself has waned considerably since the beginning, uncertainties about the effects of long COVID remain.
A study showed that 10% of adults admitted for hospital care for a COVID-19 infection screened positive for post-traumatic stress disorder (PTSD) nine weeks after discharge. With unknown health risks and the possibility of death from COVID-19, it is understandable how many might find this experience traumatic. A less expected outcome is how common PTSD is among non-hospitalized individuals with persistent symptoms. It may be that with persistent COVID symptoms, long-term hospitalization is more intense and life-threatening, while non-hospitalized recovery is less severe but comes with less support. In either case, isolation and unknown health consequences of a novel viral illness certainly contribute to the trauma some individuals experience during and after recovery from COVID-19.
While the nature of the connections is not entirely clear, COVID-19 has long-term negative impacts on mental health. Evidence-based treatments such as individual and group therapy, antidepressants, and peer support can improve outcomes. Clinicians caring for these individuals can help them assess their goals for recovery and recommend treatments that can help them regain their quality of life.
Therapy for Cognitive Impairment, Trauma, and Depression
Clinicians who remain mindful of potential trauma can identify individuals who may benefit from trauma-informed care and therapy. Cognitive processing therapy is a treatment that can help individuals adjust their perspective of traumatic events, whether they were hospitalized with COVID or supported a loved one through recovery. Cognitive-behavioral therapy (CBT) can help individuals adapt to changes in their health and functioning, establish new routines, and cope with depression.
Transcranial magnetic stimulation (TMS) is a safe, FDA-cleared treatment option for depression symptoms. Magnetic coils embedded in a padded helmet deliver targeted pulses directed at brain regions associated with symptoms, regulating neural activity, and providing relief. Treatment sessions are brief and convenient to attend around a typical daily schedule. Individuals may experience mild short-term discomforts such as a headache at the site of the pulses, but there are no long-term adverse effects.
At first glance, long COVID may seem to simply be an extension of an acute COVID-19 infection. But a closer look reveals more, including a considerable prevalence of psychological symptoms and disorders. Depression, PTSD, and anxiety are associated with long COVID, either as a pre-existing condition or the result of enduring a challenging illness with many uncertainties. While much is unknown about long-term health outcomes for long COVID, individuals in recovery need to effectively treat both physical and emotional symptoms.