July 18, 2024 – In 2021, Emma Javits, 35, thought she was having a very bad depressive episode: She was barely capable of get off the bed and do basic tasks. It took her 3 years to determine her crippling fatigue was resulting from: long COVIDnot only depression.
She had worked as a licensed clinical counselor before the pandemic and throughout her first yr there, leading weekly group therapy sessions at an intensive outpatient eating disorder clinic in Los Angeles.
For Javits and lots of other psychologists, it was difficult to carry space for each her clients' emotions and her own because the world looked as if it would change within the blink of an eye fixed. Perhaps her exhaustion was resulting from severe burnout, she suspected. As a vital employee, she was capable of get the primary COVID-19 vaccination sooner than most, but eventually contracted the omicron variant of COVID in 2021.
She had been affected by major depressive disorder long before COVID, which was treated with antidepressants. Fatigue was a reasonably common symptom when she depression crept in, but moving her body was all the time the antidote. Weekly yoga, high-intensity training and cardio were her saviours. Even during her lows, she was still capable of receive clients and train, albeit with a substantial amount of apathy and Anhedonia – the shortcoming to feel joy – which frequently accompanies depression.
“The fatigue felt different,” Javits said. “Every morning it felt like I had been hit by a truck, that's how I described it.”
Exercise was now not an option. Javits ended up having to remain home from work for months. She didn't comprehend it, but it surely was her long COVID symptoms that were stopping her body from moving as usual – but those symptoms only made her depression worse.
“Even during my depression, I never had suicidal thoughts. But a year and a half ago, I had them for the first time,” she said. “I had lived a very healthy life, so I couldn't imagine living a life and feeling like that every day.”
Identify symptoms
The list of Long-COVID symptoms has reached the hundredsmaking it particularly difficult for doctors to research each patient's health profile to find out what causes Long COVID and the best way to treat it.
Lindsay McAlpine, MD, founded the NeuroCOVID clinic at Yale Medicine in 2020. When she began her work there, she asked patients to finish the standard standardized mental health assessment tools, resembling the General Anxiety Disorder-7 (GAD-7) for anxiety and the Patient Health Questionnaire-9 (PHQ-9), which measures depression.
“At some point I just stopped doing it. Everything just came back pan-positive, and many of these people were not depressed,” she said. “There is definitely pronounced depression and pronounced long-COVID illness, but there is also a significant overlap.”
Long COVID doesn’t just show up as one thing: you possibly can experience brain fog, fatigue, headaches, tremors, heart palpitations, stomach and intestinal problems, sleep disorders, depression, anxiety and more.
But one of the crucial consistent syndromes McAlpine sees in her long-term COVID patients is chronic fatigue syndrome (CFS), which characterized by severe exhaustion that makes it almost not possible to exert oneself mentally and physically.
Another sign of Long COVID is post-exertional malaisecommon in individuals with CFS. Post-Exertional Malaise occurs when someone experiences extreme fatigue 1 to 2 days after performing easy tasks resembling brushing teeth or easy exercise resembling walking across the block – reasonably than immediately afterward.
And while it is vitally necessary to deal with the mental health symptoms of Long Covid, it's also necessary not to leap to conclusions. A patient's psychiatric history, while relevant, isn't the entire story.
“Depression and anxiety are so common in these patients that I take note of them. But so many long-COVID patients have been dismissed and manipulated, so that's not the first thing I turn to,” McAlpine said. “I've seen hundreds and hundreds of patients, and I can't think of a single one where I thought, 'Oh, that's just treatment-resistant depression.'”
Demystifying Long COVID and Depression
Researchers all over the world are still attempting to determine the best way to efficiently detect, diagnose and treat Long COVID. But some Views have shown that the reduction of Serotonin – a chemical messenger within the body that affects mood – is definitely linked to Long COVID. This could mean that the depression experienced by many Long COVID patients isn't only a response to their fatigue and other symptoms, but reasonably a physiological a part of the disease.
Fernando Carnavali, MD, a general practitioner at Mount Sinai Hospital in New York City, due to this fact believes that any further, the query needs to be asked at every patient admission: “Have you ever had COVID-19?”
Research has proven that many individuals with long COVID have mental health problems as a part of their illness. This was the case for a major percentage of Carnavali's patients, he said. Still, he's cautious about making two separate diagnoses reasonably than understanding depression as a symptom of long COVID.
“You can look at the patient's entire medical history, but at some point you have to ask, 'Have you had COVID? Did it make a difference in your symptoms?'” Carnavali said.
Early screening for long COVID may need saved Emma Javits time, money and pain. Like many other patients, it took years for her to receive an extended COVID diagnosis.
In Javits' case, her doctor thought the fatigue is perhaps a hormonal problem, so she advisable supplements. When that didn't help, she tried transcranial magnetic stimulation (TMS) – a noninvasive procedure that uses magnetic fields to stimulate nerve cells. After that, she felt a bit clearer in her head for just a few days, but it surely didn't help her debilitating fatigue. She tried ketamine therapy, a narcotic utilized in some clinics to treat treatment-resistant depression. It made her body feel relaxed, however the fatigue still didn't go away.
After years of trial and error and independent research, Javits was finally able to just accept that she could have had Long COVID, and her hypothesis was confirmed by a physician. For the past few months, she has been taking low-dose naltrexone, an opiate blocker typically used to treat substance use disorders, but recently has been studied as a treatment for extreme fatigue in post-COVID patients.
“It was almost like a turnaround. I noticed such a significant change in my energy and mood,” Javits said. She hasn't returned to her usual training schedule yet, but she's on her way there.
“I still think in the back of my mind, 'Will I ever feel normal again?'” Javits said. “I've realized that if I can exercise for 20 minutes a day, it's OK.”