Is Long COVID Being Mistaken for Mental Illness?

Long COVID, a persistent condition following acute COVID-19 infection, continues to pose challenges for the medical community due to its varied and lasting symptoms. While physical symptoms such as fatigue, brain fog, and cardiovascular issues are frequently reported, many patients also face severe neuropsychiatric symptoms (Perrin et al., 2020; Salamanca et al., 2021). These symptoms include anxiety, depression, hallucinations, and cognitive impairments, leading some healthcare providers to attribute them incorrectly to primary psychiatric disorders instead of recognizing them as part of the long-term effects of COVID-19.

This misattribution carries significant consequences, such as inappropriate psychiatric admissions, delayed proper treatment, and worsening patient outcomes. The ambiguity surrounding long COVID symptoms highlights the urgent need for systemic changes in medical education and patient care to prevent misdiagnoses and enhance outcomes for those suffering from this debilitating condition.

Understanding the Basis for Long COVID

Extensive patient reports, emerging research, and historical parallels to post-viral syndromes support the belief that long COVID is real. Studies indicate that COVID-19 can cause widespread systemic inflammation, immune system dysregulation, and damage to the nervous system, leading to long-term complications. Reports from millions of patients worldwide suffering from persistent symptoms after an initial infection further confirm its existence (Islam et al., 2020; Mardani, 2020).

The increasing body of evidence indicates that long-term COVID is not just a psychosomatic condition but a complex syndrome with biological foundations. Research has identified lingering viral particles in tissues, ongoing immune activation, and alterations in brain function in long-term COVID patients. Furthermore, conditions such as myalgic encephalomyelitis and chronic fatigue syndrome (ME/CFS) exhibit overlapping symptoms, bolstering the argument that post-viral syndromes, including long-term COVID, have a valid physiological basis (Chandan et al., 2023; Smith, 2021).

Parallels to Post-Encephalitic Disorder of the 1920s

The current challenges with long COVID mirror those observed following the 1918 influenza pandemic, which led to a mysterious post-encephalitic disorder known as encephalitis lethargica (Lechner-Scott et al., 2021). Many patients developed neurological symptoms such as extreme fatigue, movement disorders, and psychiatric disturbances. Some were misdiagnosed with schizophrenia, depression, or hysteria due to the medical community's limited understanding of post-viral conditions at the time.

Much like today’s long COVID patients, individuals affected by post-encephalitic syndrome in the 1920s often struggled to receive appropriate medical care. The similarity between the two conditions highlights the recurrent issue of dismissing post-viral illnesses as psychological rather than recognizing their physiological causes. This historical precedent warns against making the same mistakes with long COVID, emphasizing the need for improved diagnostic protocols and a deeper understanding of post-viral syndromes.

Five Ways to Consider if You Have Long COVID and What to Do

My clinic routinely sees children and adults with Long COVID for evaluation and treatment. If you are experiencing ongoing health issues after a COVID-19 infection, it is important to consider the possibility of long COVID. Here are five key signs that you might have the condition and what you can do about it:

1. Persistent Fatigue and Post-Exertional Malaise (PEM)

• If you find yourself excessively fatigued, even after minor activities, and experience worsening symptoms after exertion, you may have long COVID.
• What to Do: Prioritize rest, avoid overexertion, and consider pacing strategies to manage energy levels.

2. Cognitive Impairments (Brain Fog)

• Difficulty concentrating, memory issues, and confusion are common long COVID symptoms.
• What to Do: Engage in cognitive exercises, limit stressors, and consider professional cognitive rehabilitation therapy.

3. Shortness of Breath and Cardiovascular Issues

• Breathlessness, heart palpitations, and dizziness upon standing may indicate long COVID's impact on the autonomic nervous system.
• What to Do: Consult a doctor for testing and monitor symptoms with a pulse oximeter and heart rate tracker.

Long Covid Essential Reads

I'm the Mom, But No One Listened to Me

Long COVID Looks Like Acute Infection in the Brain

4. Neurological and Psychological Symptoms

• Anxiety, depression, mood swings, and even hallucinations have been reported.
• What to Do: Seek support from a knowledgeable medical professional, avoid unnecessary psychiatric medication, and advocate for a comprehensive neurological evaluation.

5. Gastrointestinal and Autonomic Dysfunctions

• Persistent nausea, bloating, temperature dysregulation, and unexplained weight loss may be signs of long COVID.
• What to Do: Work with a specialist to address gut health and autonomic dysfunction through dietary changes and medical treatments.

Long COVID remains a misunderstood condition, frequently misdiagnosed as a psychiatric disorder. Historical lessons and new research underscore the necessity for proper recognition and care. Patients need to advocate for thorough evaluations, and the medical community must evolve to ensure accurate diagnoses and effective treatment for those suffering from post-viral syndromes.