At long last, COVID-19 hospitalization numbers are at the lowest levels since the early days of the pandemic. Across the nation, some hospitals don’t have a single COVID-19 patient in their intensive care unit.
Even as the number of people hospitalized has plummeted, many people are still coping with long COVID, defined by the CDC as symptoms people experience four weeks or longer after the original viral infection.
COVID “long haulers” face an array of challenges, including an invisible but no less formidable foe: mental health burdens, in the form of anxiety, depression, mood disorders, post-traumatic stress disorder (PTSD) and more. These issues are often entwined with physical issues. Other symptoms may include chronic fatigue; shortness of breath; brain fog; and nerve, joint and muscle pain, just to name a few.
These patients benefit from multidisciplinary care, which is available at the UCHealth Post-COVID Clinic. As part of an ongoing series on long COVID and its treatments, UCHealth Today spoke with Dr. Thida Thant, assistant professor of psychiatry at the University of Colorado School of Medicine, and her colleague, senior instructor Dr. Heather Murray. Both provide mental health care to patients referred through the UCHealth Post-COVID Clinic.
Are medical and mental health issues sometimes connected in long COVID patients?
They are.
As Murray puts it, “The reality is our brains don’t exist in a bubble. So if you have systemic inflammation problems or viral syndromes that are affecting other organs, it makes sense that they would also affect the brain and cause other psychological symptoms. It’s unfortunately something that patients with chronic fatigue syndrome and fibromyalgia, for example, have experienced for years.”
The interconnection of medical and mental health issues highlights the importance of the Post-COVID Clinic, Murray added. “Patients may have shortness of breath, tachycardia [irregular heart rhythms] or brain fog without a lot of lab changes that are abnormal,” she said.
Can long COVID exacerbate existing mental health symptoms – and vice versa?
Yes. “The reality is that depression is very common, and a lot of people with COVID have a history of depression,” Murray said. “They’re going through a horrible time of their life, not to mention society is going through a horrible time.” She noted a significant increase in the prevalence of depressive symptoms reported since the pandemic began – perhaps as much as threefold.
Where do you provide mental health care for long COVID patients?
The hub is the Psychiatric Clinic for the Medically Complex, which predated the pandemic and is housed in the UCHealth Outpatient Psychiatric Clinic. Thant is the director and Murray is an attending physician. “We’ve been seeing long COVID patients since the summer of 2020,” Murray said.
How does the clinic help patients with the mental health symptoms of long COVID?
To begin, Murray said, “We do a whole psychological evaluation, as well as more specific psychological or cognitive screenings.” The evaluations and screenings help identify symptoms like depression, anxiety, PTSD, insomnia, fatigue, short-term memory deficits, brain fog – aka “COVID brain – and problems with attention and process, Murray added.
Explain how that information is useful for those recovering from COVID-19
Murray said that gathering in-depth psychological and cognitive information helps the team to determine if there is something more at play in a patient who exhibits long COVID symptoms.
“There could be an underlying personality disorder or major depressive disorder that could be informing the cognitive symptoms from COVID or making them worse,” she said. “Clearly, the past year and a half has been a really rough time for people. We try to see if there is something going on that is treatable to help them have a higher quality of life.”
What are some of the mental health treatments you provide?
In addition to providing individual psychotherapy and assistance with techniques like cognitive behavioral therapy, the clinic runs post-COVID survivors’ groups, one specifically for patients who were in intensive care units and another for all other patients struggling with long haul symptoms, Thant said.
The clinic also collaborates with speech language pathologists who provide cognitive rehabilitation and help patients struggling with attention, focus, short-term memory loss and other cognitive issues to “retrain their brains,” Thant added. Medications like Wellbutrin, an anti-depressant, can also help to boost focus and energy for patients facing these problems, she said, while other medications treat mood, anxiety, trouble sleeping and other symptoms.
What have been the most formidable mental health challenges for long COVID patients?
“What we’re learning is that a lot of folks are coping with it as a chronic illness,” Murray said. “It’s not something they get over in a couple of days. We’re learning from the shared experience of being a COVID patient about how hard it is to deal with it day to day.”
That experience often leads to patients facing doubt from others, Thant added. “Because there is a lot we don’t understand, there are people who question those who have these symptoms about how true it all is and how much is all in their head,” she said. “There is also frustration with the lack of treatment options.”
How do those frustrations with long COVID mental health symptoms play out in daily life?
Brain fog, or COVID brain, which exacerbates the focus and concentration problems mentioned earlier, is probably the “biggest symptom” reported by long COVID patients, Murray said. “It is really detrimental in daily life, especially when people are trying to return to work at the levels they were before. We have patients who just wear out cognitively. They can’t do the full day’s work they used to.”
Some patients suffer insomnia related to PTSD and medical trauma they endured during COVID treatment, Thant added. “They come in saying they’ve had nightmares or weird dreams and are afraid to go to sleep.”
Long COVID can also make people reluctant to return to the lives they had led, Thant noted. “People may be afraid to be around other people who had COVID,” she said. “They have fears of reinfection, as well as of resurgences and recurrent lockdowns.”
The group sessions can help to allay that uneasiness, Thant said. “In group you meet other people who understand your experience and are on that journey with you,” she said. “People identify that as one of the most helpful things we offer – being able to share the fear of the unknown together.”
Are there resources long COVID patients can use to manage symptoms themselves?
Yes. Dr. Melanie Dae, a senior instructor of psychology at CU, recommends several apps for help with sleep and relaxation techniques. Some examples:
- CBT-i Coach from the Department of Veterans Affairs
- Calm
- BetterSleep (formerly Relax Melodies)
- Breathe2Relax
- Tactical Breather
- Stop Breathe Think
Exercise can also be helpful, but Thant cautioned people to manage their activity levels carefully. “You don’t want to avoid activities like exercise, as it is ultimately helpful, but it is better to do a more tiered/step-wise approach back to activities you may be finding exhausting post-COVID,” she said.
Patients can also help themselves by recognizing that there is no shame in seeking help for their mental health issues, just as they would a medical problem like high blood pressure, Murray added.
“There are certain things in your life that happen and you need help,” she said. “You can spend time with your family, you can try to get better sleep, you can exercise. But some of us have really stressful lives that we can’t change in the moment. If we have symptoms from that, it’s okay to get that extra support, just as you would if you had diabetes that you’re doing everything you can to keep under control. There is nothing wrong with that.”
What is the state of psychiatric/mental health care for long COVID patients today?
“There is still a shortage of care,” Thant said. “There are only a few places in Colorado that provide it. That, combined with the increase in the mental health burden from the pandemic and the wait list for psychiatric care overall, has made it really hard for our patients.”
Is there a ‘typical’ long COVID patient that you care for?
“We’ve seen patients from across the spectrum of illness,” Thant said. “We’ve not found a 100% correlation between the severity of the COVID illness and the severity of the long haul symptoms. We’re seeing patients who were not even medically admitted to the hospital.”
After two years of COVID-19, what insights have we gained about long COVID?
“There seems to be a large inflammatory component to what’s going on that oftentimes leads to long haul symptoms,” Murray said. “I think that’s important to figuring who is at risk and what are some of the possible treatments. Some patients make steady progress toward getting better within a few weeks or months. Other folks have a real up and down and waxing and waning experience. They get better, then get sick again or overexert themselves and backslide. There seem to be some pathophysiological factors that produce symptoms that mimic depression.”
For more information on post-COVID mental health issues and resources for patients and providers, see the Department of Psychiatry’s “Mind the Brain: Mental Health in the Time of COVID-19.”