How could long COVID impact your mental health?

The pandemic has taken its toll on our mental health, leading to anxiety, depression and loneliness. But for people living with 'long COVID' - symptoms that last weeks or months after the infection has gone - the psychological impact can be devastating.

"Long COVID is a condition where people continue to experience symptoms of COVID-19 for longer than usual after initially contracting the SARS-CoV-2 virus," says Alejandra Sarmiento, a psychotherapist at The Soke, a mental health and well-being clinic in London.

"They can experience these symptoms for weeks, months or possibly years after the initial infection, whether they required hospitalisation or not. Sufferers of long COVID experience fluctuating clusters of both physical and mental symptoms such as loss of taste, shortness of breath, cognitive dysfunction and fatigue."

Long COVID and mental health

Recovery from COVID-19 can take a few weeks or even months. But for some people, the physical, mental and emotional symptoms can linger for much longer and like any long-term, debilitating disease, it can affect someone's mental health. When we don't recover within an expected time frame, it can lead to frustration, confusion and fear.

"The more that time goes on and the more that this reality persists, the greater the impact on someone's mental well-being," says Sarmiento. "Fear and low mood are likely to set in. In turn, these feelings of anxiety and depression are further exacerbated by the physical exhaustion often experienced with long COVID."

In combination with the inability to work, socialise and exercise, these factors can have a significant and devastating impact on mental well-being. People may have spent long periods of time in hospital, which can be deeply stressful. Even the physical symptoms - the feeling of not being able to breathe - can be traumatic. For those already struggling with a mental health problem, long COVID may exacerbate psychological issues further, too.

The links between the virus and mental health

Just over a year has passed since the start of the outbreak and the first lockdown was introduced in the UK. However, preliminary research has already suggested there may be a connection between COVID-19 and mental health problems. A recent systematic review identified that while physical symptoms receive most attention, the effects of COVID-19 upon mental health may be equally important.

There is not much data on the psychological impact of long COVID. However, one study suggested those who experience lingering symptoms may be more likely to be diagnosed with psychiatric conditions, with an estimated 9.9% of people experiencing mood disorders. However, the researchers suggested this may be the tip of the iceberg as it relied on reporting via electronic health data, rather than the active screening of symptoms.

Scientists also now know that COVID-19 isn't just a respiratory illness, but a disease that affects many critical organs, including the brain. Numerous reports show COVID-19 patients experience neurological complications, such as confusion, delirium, and other cognitive impairments. Scientists are still working to understand how the virus interacts with the central nervous system, but this may also help explain some of the psychological effects of the disease.

Long COVID and PTSD

During previous severe coronavirus outbreaks, research has shown a link between infection, survival and post-traumatic stress disorder (PTSD). Last year, a study published in The Lancet Psychiatry found 33% of those who survived the 2002 outbreak of severe acute respiratory syndrome (SARS) and 2012 Middle East respiratory syndrome (MERS) suffered from PTSD post-illness.

"PTSD is an unfinished response to an earlier threat in our lives. It is post-traumatic, in the sense that it refers to our own experience of a traumatic event that was overwhelming," Sarmiento explains.

"Our nervous system responds to that traumatic event and becomes dysregulated. If we stay stuck in this place of overwhelming confusion and fear our nervous system remains off balance. This dysregulation becomes the foundation for a stress disorder, resulting in, for example, anxiety and depression. We can, therefore, see how long COVID could easily lead to PTSD."

Likewise, looking after someone with COVID-19 or long COVID may have a lasting psychological impact too. "Caring for a loved one in pain is always a stressful situation. If this situation is ongoing, as is the case with long COVID, then the impact on the carer is increasingly significant," says Sarmiento.

"Added to this, long COVID is still an unknown in many ways. We cannot predict the length or course of the illness. There is no timeout for the carer, who may also start suffering emotionally, mentally and possibly financially if caring duties impact on their own working lives."

Where to get help and support

If long COVID is affecting your mental health, or you are struggling to support someone with lasting symptoms, it's important to seek professional help.

Speak to your GP

"While it's not always straightforward to identify a single factor that leads to a mental health problem, it is possible that long COVID could contribute. If you are feeling mentally unwell, it's important to speak to your GP for help and advice," says Stephen Buckley, head of information at the charity Mind.

Your doctor will be able to provide advice and help you decide the right course of action, whether it is therapy, medication, or a combination of both.

For people in England, there are now dozens of long COVID clinics, where multi-disciplinary teams can assess all aspects of your health. Your GP may be able to refer you. You can also log on to the NHS's Your COVID Recovery website, which provides advice on psychological as well as physical symptoms.

Speak to other people

We often feel the need to keep our problems or negative emotions to ourselves, especially if we know other people are struggling too. However, it's important to speak to trusted family or friends about how we feel, to help lighten the load and know you aren't alone.

"COVID is a real, continuous and ambiguous threat. It is everywhere and nowhere. We do not know its expiration date," Sarmiento says. "The fallout from this pandemic is, inevitably, physical, financial, emotional and mental for sufferers, for frontline workers and for carers.”

Go easy on yourself

There is a big push to return to 'normality' as lockdown lifts. For many people, however, the pandemic isn't so easy to forget. We've lost loved ones, seen relatives and friends struggle with lasting symptoms and experienced fear and isolation on unprecedented levels.

Caring for someone with a long-term health condition can be difficult. Charities like Mind and Carers UK can provide support and advice if you are struggling.

"You need to be aware of the additional stress and worry that comes with caring for someone, as well as the risk of feeling isolated and alone," says Sarmiento. "It is important that as a carer you take time to look after yourself as well - for example, by making sure you don't take on too much, and talking to someone about how you are feeling."

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