June 2, 2023 – Anxiety, depression and COVID-19 could be a bad combination on your brain – and your long-term health.
Anxiety and depression Before a COVID infection increases the danger of long-COVID disease, Researchers have found out.
People with long COVID disease who develop anxiety and depression after An infection can Brain shrinkage in areas that regulate memory, emotions and other functions in addition to disorders of brain connectivity.
While many questions remain about these intertwined relationships, the associations are usually not a complete surprise. Experts already know that depression and anxiety are linked to inflammation and immune deficiencies, which can help explain the link between these mental illnesses, the danger of long COVID, and the changes within the brain.
The brain changes related to COVID infection have been a priority for researchers because the starting of the pandemic, when researchers on the UK Biobank found Brain atrophy, lack of gray matter and decline in cognitive abilities in COVID-infected people in comparison with non-infected people.
Terms and Conditions
The implications of research linking anxiety, depression and Long COVID are far-reaching. According to the CDC, 12.5% of adults within the United States suffer from anxiety (in addition to nervousness and worry) regularly, and the most recent Gallup poll found that just about 18% of adults currently suffer from depression or are being treated for depression.
As of May 8, 10% of infected adults within the United States suffered from Long COVID, in line with the CDC, and of adults within the US who've ever been infected, 27% have reported Long COVID. Long COVID is Are defined by the CDC as symptoms akin to fatigue, brain fog and cough that last more than 4 weeks and by the World Health Organization as symptoms that last 3 months or longer.
Here is a summary of research on mental health and the danger of long-term impacts from COVID-19, in addition to other research showing that this risk might be reduced by following healthy habits.
Existing depression, anxiety and long-COVID risk
A history of mental health problems – including depression, anxiety, worry, perceived stress and loneliness – increases the danger of “long COVID” disease within the event of infection, Harvard researchers found.
The researchers evaluated data from three large, ongoing studies involving nearly 55,000 participants to find out the results of high levels of psychological distress before COVID infection.
“Our study was purely survey-based,” said Dr. Siwen Wang, the study’s lead writer and a research fellow at Harvard University’s TH Chan School of Public Health.
At the beginning of the survey in April 2020, not one of the participants reported having a current or past COVID infection. They answered questionnaires on psychological distress at baseline, at 6 monthly time points, after which quarterly until November 2021.
During follow-up, 3,193 people reported a positive COVID test and 43% of them, or 1,403, developed Long COVID. This number could appear high, but 38% of the 55,000 were energetic healthcare employees. In the ultimate questionnaire, they indicated whether their symptoms lasted 4 weeks or longer and thus had Long COVID in line with the CDC's standard definition.
Wang's team then examined the psychological state of the infected participants. Anxiety increased the danger of long-term COVID disease by 42%, depression by 32%, worry about COVID by 37%, perceived stress by 46%, and loneliness by 32%.
COVID patients with a history of depression or anxiety are also more likely than others to report cognitive problems within the weeks following a COVID infection and develop brain fog and Long COVID. Researchers at UCLA found out. They studied 766 individuals with a confirmed COVID infection; 36% reported that their pondering was impaired inside 4 weeks of infection. People with anxiety and depression were more prone to report these difficulties.
Long COVID, then anxiety, depression, brain changes
Even mild cases of COVID infection can result in long COVID and brain changes in individuals who experience anxiety or depression after infection, says Clarissa Yasuda, MD, PhD, assistant professor of neurology on the University of Campinas in Sao Paulo, Brazil, who has researched the results of long COVID on the brain, whilst she copes with life as a protracted COVID patient herself.
In one among her studies, which she presented in April on the 2023 American Academy of Neurology meeting, she found brain changes in individuals with anxiety, depression and COVID, but not in infected individuals who had neither mental health problem. She studied 254 people, with a median age of 41, about 82 days after their positive PCR test for COVID. Each filled out a normal questionnaire on depression (the Beck Depression Inventory) and one other on anxiety (the Beck Anxiety Inventory). She further divided them into two groups – the 102 with symptoms and the 152 who had neither symptoms of depression nor anxiety.
Brain scans showed that COVID patients who also suffered from anxiety and depression experienced shrinkage of the limbic system (which helps process emotions and memories), while those infected without anxiety or depression didn't. The researchers then scanned the brains of 148 healthy people without COVID and located no shrinkage.
The atrophy, says Yasuda, “is not something you can see with the eye. It was only detected through computer analysis. Visualization in MRI is normal.”
The variety of individuals with mental health problems on this study was surprisingly high, said Yasuda. “It was fascinating to us that we noticed that many people had both symptoms, anxiety and depression. We did not expect this to be the case to this extent.”
The researchers discovered a pattern of changes not only in brain structure but additionally in brain communication. They found these changes by utilizing special software to research the brain networks of some participants. Those who suffered from anxiety and depression experienced extensive changes in function in each of the 12 networks tested. Participants without mental symptoms showed changes in just 5 networks. These changes are enough to steer to problems with pondering and memory, Yasuda said.
Explanation of the links
Several ideas have been proposed to elucidate the link between psychological stress and the danger of long-COVID disease, Wang said. “The first and most common mechanism for long-COVID disease is chronic inflammation and immune dysfunction,” she said. “Several mental illnesses such as anxiety and depression are related to inflammation and dysfunction, and this may be the link between depression, anxiety and long-COVID disease.”
Another, less common hypothesis, she said, is that “people with long COVID have more autoantibodies and are more likely to have problems with blood clotting. These have also been found in people with anxiety, depression or other mental health problems.”
Other researchers are studying the results of COVID infections on the brain more broadly. When German researchers examined the brains and other body parts of 20 patients who had died from causes aside from COVID but had documented COVID infection, they found that 12 Accumulations of the SARS-CoV-2 spike protein in brain tissue in addition to within the skull and meninges, the membranes that line the skull and spinal cord. This was not the case in healthy controls.
The findings suggest that the persistence of the spike protein may contribute to the long-term neurological symptoms of Long COVID and can also result in understanding the molecular mechanisms and therapies for Long COVID, the researchers said of their preprint report, which has not yet been peer-reviewed.
In one other current Study, Researchers from Hamburg conducted neuroimaging and neuropsychological studies on 223 individuals who were unvaccinated and had recovered from mild to moderate COVID infections and compared them with 223 healthy controls who had undergone the identical tests. In those infected, they found changes within the white matter of the brain in the primary yr after recovery, but no deterioration in cognitive function. They concluded that the infection triggers a persistent neuroinflammatory response.
Can the changes within the brain be reversed? “We don't have an answer at the moment, but we're working on it,” Yasuda said. At the moment, she is speculating concerning the return of brain volume: “I think that will happen for most people. But I think we need to treat the symptoms. We can't ignore the symptoms of Long COVID. People are suffering a lot, and this suffering is causing some brain damage.”
Lifestyle habits and long-COVID risk
In the meantime, healthy lifestyle habits in infected people can reduce the danger of long-COVID disease, in line with research by Wang and her colleagues. They followed almost 2,000 women with a positive COVID test for 19 months. Of these, 44% or 871 developed long-COVID disease. Compared to women who didn't follow any of the healthy lifestyle habits studied, those with five to 6 of those habits had a 49% lower risk of long-COVID disease.
Habits included: a healthy BMI (18.5 to 24.9), never smoking, a minimum of 150 minutes of moderate to vigorous physical activity per week, moderate alcohol consumption (5-15 grams per day), high weight loss program quality, and good sleep (7-9 hours per night).
Long-term solutions
Yasuda hopes that mental health care – each for those infected and people not infected – can be taken more seriously. In her comment Of her own long-term COVID experience, she wrote, amongst other things: “I fear for the numerous survivors of COVID-19 who do not have access to medical care for their post-COVID symptoms. … The mental health system must be prepared to accommodate survivors with a variety of neuropsychiatric symptoms, including anxiety and depression.”