Why Is There an Increase in Depression After COVID?

Are you one of the millions of people who contracted COVID? If so, you understand the physical symptoms that made you feel miserable for days or even weeks. However, you may have also felt fatigued, unmotivated, tearful, irritable, and sad even after the physical symptoms were gone.

It’s true that living through a global pandemic is hard on our mental health, even if we haven't gotten COVID. Yet researchers believe being depressed is not just the result of feeling sick, isolated, or fearing for our own health or that of our loved ones—COVID can actually create changes in your brain that cause psychiatric symptoms.

Scientists have learned a great deal about COVID and how it passed from one person to another, yet we don’t know the extent to which COVID can have an impact on the human brain and cause psychiatric symptoms. A recent study in The Lancet reported persistent depression and anxiety can follow severe cases of COVID, however, other research has shown that severe symptoms are not necessary for this to happen.

Depression is a medical condition and is the result of many factors. Symptoms of depression include low energy, loss of interest in usual activities, decreased appetite, poor sleep, and low mood. These are also seen in people suffering from COVID. However, it seems that depression following a bout with this illness is not just the consequence of having “felt miserable.” The isolation and hospitalization that many faced, as well as fear of death, are significant stressors.

When your body is stressed, it turns on a part of your nervous system called the autonomic nervous system. This system is “automatic” and not under your control. The portion of this system that lights up in an emergency is the sympathetic nervous system and prepares you for a “fight or flight” situation. This results in your body’s initiation of an inflammatory response, which is a central theory that explains how infections such as COVID lead to psychiatric illness.

Edward Bullmore, a British psychiatrist, published a book in 2019 entitled The Inflamed Mind. He argued depression and other mental illnesses may be due to the activation of your immune system. Researchers previously believed the brain had its own impenetrable “wall” known as the blood-brain barrier. However, we now know open channels exist between the brain and elements of the immune system. Bullmore argued when inflammation occurs, proteins called cytokines cross the blood-brain barrier leading to changes within the brain that cause depression. Cytokines appear to instigate depression by impacting brain chemicals called neurotransmitters, causing their levels to drop below healthy concentrations. Studies have consistently found higher levels of inflammatory proteins in patients with major depressive disorder.

The effects of SSRIs on patients with COVID

Just as antidepressants are often prescribed for patients with depression or to increase their brain’s level of neurotransmitters, there has also been a preliminary study using antidepressants to treat patients with COVID.

The study showed rapid improvement in decreasing reports of depressive symptoms and in addition, a second effect was that the SSRI showed promise in decreasing the inflammatory properties of the virus itself.

The effects of SSRIs on COVID have recently been even further demonstrated in a study out of Canada in late 2021. Scientists used fluvoxamine, an SSRI, in nearly 1,500 Brazilian patients with chronic illnesses who were recently infected with the coronavirus. Half took the antidepressant at home for 10 days; the rest got a placebo. They were followed for 4 weeks to determine who required hospitalization or spent extended time in an emergency room when hospitals were full.

In the group that took the drug, 11 percent needed hospitalization or an extended ER stay, compared to 16 percent of those on “dummy” pills. The results published in Lancet Global Health were so strong that independent experts monitoring the study recommended stopping it early because the results were clear.

A month later, an even larger study out of the University of California, San Francisco, and a Stanford research group published their work which analyzed electronic health records from a large database that had information from almost 500,000 patients across the U.S. This included 83,584 adult patients diagnosed with COVID between January and September 2020. Of those, 3,401 patients were prescribed two SSRIs, fluoxetine, and fluvoxamine.

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The results showed that patients taking fluoxetine were 28 percent less likely to die; those taking either fluoxetine or fluvoxamine were 26 percent less likely to die, and the entire group of patients taking any kind of SSRI was 8 percent less likely to die than the matched patient controls.

Why were these SSRIs effective in treating COVID? They work by increasing the brain’s level of serotonin, a neurotransmitter that helps to improve mood and decrease anxiety. Serotonin also influences the immune system. In patients with COVID, it may work to prevent or limit the cytokine release process that is partly responsible for worsening the inflammatory component of the illness. In this way, serotonin may also have some ability to decrease pain as well as the formation of blood clots, which was one of the risks of severe COVID infection and often led to death.

It’s been a hard time for many, especially those of you who have had COVID and are dealing with residual mental health issues. As the number of cases decreases, and we return to some sort of “normal,” we will continue to learn even more about the way our mental health has been affected. The good news is treatment options are available.

What depressed patients with COVID can do

What can you do if you have been infected with COVID and still experience symptoms of depression? As discussed, antidepressants show promise in relieving depressive symptoms as well as altering the inflammatory properties of the virus itself. Telehealth has become more available since the pandemic, which can provide more convenient options to access mental health care even in remote areas. Peer support can be helpful, particularly after disasters.

A useful guideline for living through a global emergency is to try and avoid spending every moment as if it is a crisis. Maintain a regular routine as much as possible. Preserve contact with friends and family, even if only on a virtual basis. Try and limit alcohol consumption that over time can lead to or worsen depressive symptoms. Try to engage in 20-30 minutes of physical activity per day, and finally, limit your time watching the news or scrolling through social media.

Researchers studying the link between serious mental illness and disasters found depression was the second most common mental health condition among disaster survivors, after post-traumatic stress disorder (PTSD). The encouraging news: Most people who developed depression after such events had a high rate of recovery.

There is hope.