The mental health impact of the COVID-19 pandemic has been hitting the headlines repeatedly over recent months for many reasons; not just in relation to those suffering under the pressures of lockdown or those battling on the frontline, but for business owners facing economic struggles, children missing out on schooling and for those who’ve been left bereaved. But what about those who’ve been struck down with the virus itself?
Being laid low with a virus like a winter cold or a dose of flu has long been known to have an impact on mood, often causing the sufferer to feel depressed and miserable, both during the illness and after. However, the advent of COVID-19 has brought the issue of how viruses (in particular SARS-CoV-2) affect brain health and mood into sharp relief.
We’re used to thinking of COVID-19 in terms of its physical manifestations – fever, headache, persistent cough, respiratory issues, etc – but there is mounting evidence that the virus may also play havoc with your mind. Odd neurological complications, from loss of taste and smell to seizures, have appeared in many COVID-19 patients, and the numbers complaining of lingering brain fog long after the acute infection are growing.
Worryingly, initial data suggests that one in eight people who have had COVID-19 are diagnosed with their first psychiatric or neurological illness within six months of testing positive for the virus. Diagnoses ranged from ischaemic stroke, Guillain-Barre syndrome and Parkinson’s Disease, through to dementia, depression, anxiety, substance misuse and insomnia. The data suggests that this figure rises to an alarming one in three for patients with a previous history of such illness, and that most diagnoses were more common after COVID-19 than after influenza or other respiratory infections.1
This study adds to previous research which suggested that nearly one in five COVID-19 patients later become diagnosed with a mental illness, such as anxiety, depression or insomnia, within three months of testing positive for the virus.2
In October 2020, researchers from UCL and UCLH in the UK published details of more than 40 UK COVID-19 patients whose complications ranged from brain inflammation and delirium to nerve damage and stroke,3 and another recent study makes a possible link between COVID-19 and psychosis in a small number of patients.4
Inflammation and neurotoxicity
So, what might be lying at the root of these diagnoses? Well one hypothesis relates to the “cytokine surge” theory, which involves an over-production of immune cells ultimately leading to an excessive inflammatory response. It’s thought that the virus gets disseminated in the body, and then manages to cross the blood brain barrier causing neurotoxicity and inflammation. However, it’s difficult to know whether this response is specific to the COVID-19 virus or due to the effects of viruses in general, and now appearing more frequently due to the huge numbers of people infected with COVID-19. There is a growing body of evidence that exposure to infections, particularly viruses, can be associated with the development of a psychotic disorder and many cases of post-influenza psychosis were reported during and after the 1918-19 Spanish influenza pandemic.
The role of immune mediators in neuropsychiatric disorders has also drawn significant interest over the last decade. Elevated levels of proinflammatory cytokines have been found in a number of psychiatric conditions including obsessive compulsive disorder (OCD), attention-deficit hyperactivity disorder (ADHD), schizophrenia and depression.
Further studies are needed to establish whether a diagnosis of a psychiatric disorder can be directly linked to getting COVID-19 and the impact of the virus on the brain itself; existing data is likely being influenced by concomitant factors such as socio-economic background, smoking, use of drugs, and general stress imposed by the pandemic. Such studies are now under way, including one by scientists in the UK who have formed a partnership to explore the neurological and neuropsychiatric complications of COVID-19.5
The full extent of the effects of COVID-19 on patients’ long-term health is not yet known and will no doubt be played out over the coming months and years, but initial data suggests that the toll of the virus on the mental health and brain function of those who are infected, should not be underestimated.
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1. Six-month Nuerological and Psychiatric Outcomes in 236,379 Survivors of Covid-19. Taquet M, Geddes JR, Husain M et al, Jan 2021 Pre-print. https://doi.org/10.1101/2021.01.16.21249950
2. Bidirectional associations between Covid-19 and psychiatric disorder: retrospective cohort studies of 62,354 Covid-19 cases in the USA. Taquet M, Luciano S, Geddes JR, Harrison P, Nov 2020 https://doi.org/10.1016/S2215-0366(20)30462-4
3. The emerging spectrum of Covid-19 neurology: clinical, radiological and laboratory findings. Paterson RW, Brown RL, Benjamin L, Nortley R et al. Brain, Volume 143, Issue 10, October 2020 https://doi.org/10.1093/brain/awaa240
4. Covid-19 and psychosis risk: Real or delusional concern? Watson CJ, Thoms RH, Solomon T, Neuroscience Letters, Vol 741, Jan 2021 https://doi.org/10.1016/j.neulet.2020.135491
5. Effects of Covid-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study. Carr MJ, Steeg S, Webb RT et al, Jan 2021 https://doi.org/10.1016/S2468-2667(20)30288-7