Now that the coronavirus is a fact of life, it’s still important to prevent infection–and the mental health effects connected to long Covid.

As of October 2022, over 628 million people have been infected with Covid, globally. Worse, experts estimate that nearly 1 in 5 US adults who have had Covid develop long Covid symptoms. While that’s scary in its own right, long Covid’s mental health effects add insult to injury.

What are the mental health symptoms associated with long Covid?

Most people who have Covid-19 recover within a few weeks. However, as with many other illnesses and infections, we now know that Covid-19 can also have longer-term effects. The term “long Covid” has been used to describe symptoms that continue after the acute infection period is over. These “post-acute sequelae of Covid-19” (PASC) include mental health effects such as:

  • Fatigue
  • Brain fog
  • Depression
  • Anxiety
  • Panic
  • Nervousness or restlessness
  • Suicidal thoughts

Researchers also discovered that a significant number of Covid-19 survivors exhibit symptoms of post-traumatic stress disorder (PTSD), sleep issues, and obsessive-compulsive disorder (OCD). Other research revealed that since the onset of the virus, there has been an increase in the prescription of antidepressants, intimate relationship violence, and suicidal thoughts. It seems that after recovering from the virus, those who have had Covid-19 tend to have an increased chance of developing a mental health issue.

Is depression a side effect of long Covid?

The connection between long Covid and depression is not simple. However, the relationship clearly exists and deserves acknowledgement.

After going through a major experience like Covid, it’s common to feel down, even without a physical cause. Processing your experiences and their effects on your life might take some time, and your mood may be greatly affected if you haven’t been able to engage in the things you normally undertake.

In addition to the mental causes of depression symptoms in long Covid, there are also clear physical underpinnings to post-Covid low mood: autonomic nervous system changes, increased cytokine load, and changes to blood sugar metabolism.

Interestingly, people who develop long Covid are also more likely to have had depression prior to their infection. So the connection between long Covid and depression may go both ways.

Is anxiety associated with long Covid?

Researchers at Northwestern University have shown that new anxiety symptoms are connected to brain inflammation and nerve cell damage in long-term Covid patients, even those who were never hospitalized.

Additionally, blood sugar metabolism issues can affect anxiety in long Covid patients (more on that below).

Autonomic dysfunction associated with long Covid can also make people feel anxious for no good reason.

Can long Covid cause brain fog?

Some sufferers of the coronavirus experience brain fog while they are recovering. Brain fog also frequently appears in long Covid, perhaps due to inflammatory or immune system effects. According to Harvard Medical School, 22% to 32% of Covid patients will have symptoms of brain fog after their acute infection.

However, it’s important to mention that brain fog can occur in anyone, not just those who were hospitalized for coronavirus. Similar symptoms could appear as a result of non-Covid infections, a minor head injury, or menopause. If you experience stress, anxiety, or depression, brain fog is also typical.

Stress or lack of sleep both have effects that can mirror brain fog–which is not the same as dementia and does not indicate that the brain is structurally damaged.

Brain fog usually passes after some time, whether due to Covid or other causes.

How does long Covid cause mental health symptoms?

There are a few body systems impacted by long Covid, which can contribute to mental health symptoms. See more in-depth discussion, below.

This TikTok video from Crawford Wellness describes long Covid’s psychological impact via physical changes to your body: https://www.tiktok.com/t/ZTRDGqYL7/?k=1

Changes to your gut bacteria (and your gut-brain axis)

The gut microbiome, which consists of the billions of bacteria, fungus, and other microbes that live in the digestive tract, is being linked to Covid-19 severity in a growing body of research. Additionally, because the gut plays a significant role in immunity, a disordered immune response to a Covid-19 infection brought on by local microbes may have an impact on the healing process as well.

That being said, studies also showed that changes in gut bacteria might affect your mental health. Gut bacteria changes have been linked to causing several mental illnesses including anxiety and depression.

Changes to your brain’s grey matter

According to a new study, Covid-19 may result in more brain tissue damage and gray matter loss in comparison to others who have not been exposed to the virus. People who participated in the study had their brains scanned both before and months after contracting Covid.

The ramifications of the changes, according to neurological specialists, are uncertain and do not necessarily imply that people would suffer permanent harm or that they will have a substantial impact on thinking, memory, or other abilities. On the other hand, studies also showed that lower levels of gray matter in the brain are linked to an increased risk of mental health conditions like depression and psychosis.

Changes to your autonomic nervous system

An article in the journal Nature describes the autonomic nervous system changes associated with post-Covid low mood. One major autonomic feature of long Covid appears to be a change in heart rate variability. Heart rate variability reflects the nervous system’s ability to respond as it should, and tells us something about the balance between parasympathetic and sympathetic activity in a person.

The “parasympathetic/sympathetic balance” is another way of saying: the balance between “rest and digest” and “fight or flight” modes.

These two nervous system states are often experienced as different moods or emotional states, and relate to our feelings of anxiety, fatigue, and safety. Thus, autonomic changes after Covid infection can clearly impact mental health.

Can people with long Covid recover from brain and mental health symptoms?

Yes, but not in 100% of cases. Regardless, it’s important to have hope (for your sake, no-one else’s) that your brain fog, anxiety, depression, and even suicidal thoughts will improve.

What can be done about mental health struggles associated with long Covid?

1. Do low-key exercise to help autonomic dysfunction

Exericse is known to help autonomic dysfunction and other myriad symptoms of long Covid. Autonomic dysfunction can contribute to the feelings of anxiety, panic, sleep issues, memory issues, and even depression felt by many long Covid patients.

Improvements in vascular function, blood volume expansion, cardiac remodeling, insulin resistance, and renal-adrenal function brought on by exercise may help treat symptoms of long Covid. These body systems impacted by exercise can all also affect mental health.

The tricky part is the chronic fatigue that many long Covid patients experience. In chronic fatigue syndrome, post-exertional malaise is a defining feature. This is when people feel disproportionally fatigued after exercise.

For people with autonomic dysfunction, exercise is still important even with the risk of post-exertional malaise. So you may want to exercise with low intensity, at your own pace, not according to some pre-determined schedule as in “graded exercise therapy.”

That might mean walking slowly and sitting a few minutes at each bench you pass. Or, something is better than nothing: you might simply walk a lap around your house every day, until your capacity for exercise increases. Do 2 squats a day. 10 jumping jacks and then lay back down for an hour. Try whatever works for you and feels doable. One minute is better than no minutes.

The number one thing to keep in mind, is not to push yourself too hard. That will defeat the purpose of exercise in battling long Covid. Baby steps!

2. Talk about your long Covid mental health experience

Talk with a healthcare professional, a mental healthcare provider, or at the very least, a trusted peer. 

Opening up about your experience may free up some brain space when you’re having mental health struggles. It also gives others a chance to help support you through the difficult times. Further, if you don’t share what you’re going through, it’s harder to receive whatever help may be available.

3. Get lots of sleep

Mental health and sleep are closely related to each other. And, both are related to your immune and autonomic nervous systems (which may underlie long Covid mental health symptoms). Your mental health and psychological state are impacted by sleep deprivation. And, when long Covid creates lasting changes, sleep can give your body the opportunity to heal.

Poor sleep hygiene is a frequent contributor to sleeping issues. Creating sleep-friendly routines and sleeping environments can help to significantly lower sleep disruptions.

Steps that can be taken for healthier sleep habits include:

  • Establishing a regular bedtime and sleep schedule
  • Finding ways to relax as part of a regular bedtime routine, such as through the use of relaxation techniques
  • Avoiding caffeine, alcohol, and tobacco in the evening
  • Before going to bed, dimming the lights and putting away any electronic devices for at least an hour
  • Getting regular exercise and daytime exposure to natural light
  • Making the most of your mattress, pillows, and bedding for comfort and support
  • Minimizing excessive light and noise that might interfere with sleep

4. Eat balanced foods regularly

Anyone who has ever been hangry knows that food can impact your emotions, even if you don’t have long Covid. Blood sugar fluctuations are associated with depression, anxiety, “weakness, mental dullness, confusion, and fatigue.” As WebMD puts it: “When your blood sugar drops, your body tries to bring it up. It pumps out epinephrine (adrenaline), a ‘fight or flight’ hormone that…can make you feel cranky and anxious.”

But for people who have had Covid, blood sugar may become even more of a factor in mental health. According to research published in the journal Nature, long Covid alters your body’s metabolism and how it processes glucose and insulin–making it easier for you to experience symptoms related to blood sugar. In fact, people who have recently had Covid may be diagnosed with a “transitory form” of diabetes.

So, you’ll want to prioritize balanced foods that don’t put your blood sugar on a roller coaster (these are often referred to as low-glycemic index foods). The Association of UK Dietitians provides a resource for food choices in long Covid patients.

Regardless of these more complex considerations: when you have post-viral illness, fatigue is a major drain on your mental health, and missing mealtimes is one of the quickest ways to make yourself feel fatigued, virus or not.

5. Limit your alcohol and caffeine intake

It’s not clear how caffeine interacts with long Covid on a fundamental level. And there is evidence it might be helpful surrounding acute infection. However, caffeine’s known interference with sleep suggests it’s not a good idea for “long haulers.”

On the other hand, alcohol intake may not even be a concern, since so many long Covid patients cannot tolerate alcohol. Many find that alcohol worsens their persistent symptoms. Even if you don’t experience the exacerbation, staying away from alcohol is a kind choice for your immune function and sleep.

Also, interestingly: people who drank frequently prior to Covid infection are more likely to have long Covid mental health symptoms.

More information on caffeine and Covid
More information on alcohol and Covid

6. Quit smoking

Long-term Covid symptoms will exacerbate as a result of nicotine’s effects on your heart rate, blood pressure, irritation of your respiratory system, and lung function. While giving up can be difficult, your breathing and circulation will immediately become better.

The takeaway about long Covid and mental health

Know that your mental health really can be impacted by long Covid–it’s not all just “in your head.” And if anyone tells you otherwise, you can point them to the information here.

That said, it’s even worse for your mental health when you have nobody who “gets” what you’re going through. If you want to talk about it in a safe, understanding space, Supportiv chats are available 24/7, every day, without an appointment. Just click Chat Now, and you can talk to helpful peers (with a professionally-trained moderator) – usually in one minute or less.