The psychiatrist talked about the features of post-covid depression

Shortness of breath, increased blood pressure, pain in the heart and stomach, fatigue, decreased concentration — patients with COVID-19 have been seeing doctors for months with such complaints. And it is often only six months later that it turns out that the cause is not a physical illness, but post—cystic depression and anxiety, which are "masquerading" as somatic symptoms. Daria Golovkina, PhD, an assistant at the Department of Psychiatry and Narcology at Sechenov University, who conducted research on post-covid mental disorders, told Izvestia on October 10 about what increases the chances of encountering these conditions and how easily they can be treated.

The COVID-19 pandemic began just over five years ago and was officially declared over on May 5, 2023. Now, according to the World Health Organization (WHO), coronavirus infection has become a seasonal respiratory disease along with the flu. Since the beginning of the pandemic, many researchers have recorded an increase in the prevalence of depression and anxiety disorders. Scientists have given very different numbers of cases of depression and anxiety among those who have had COVID-19, ranging from 12 to 46%.

"But the specific characteristics of the course of post—cystic depressive and anxiety disorders, the timing and risk factors for their development have not been studied enough, so we conducted our own research at Sechenov University," Golovkina said.

The depression diagnosed in patients who had suffered from COVID-19 was pronounced — 50% moderate and 31% severe — in this condition, a person may not even have the strength to wash or tidy up the room, the doctor explained. 26% of the study participants had an anxiety disorder — they either had panic attacks or constant anxiety that prevented them from living a full life. At the same time, most people had symptoms of depression and anxiety combined.

"It's a myth that a person can have either one or the other. Very often, a patient with depression, in addition to depression, bad mood, and loss of strength, has background anxiety," the doctor explained.

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A third of patients who suffered from COVID-19, and then depression or anxiety disorder, were found to have cognitive impairments. But they were light, at most moderate. We are talking about a decrease in concentration, memory, and "fog" in the head. According to Golovkina, this is typical not only for post-cystic disorders, but also for depression and anxiety in general. A person does not have the strength for anything, his thinking slows down, his concentration decreases. She noted that with anxiety, a constant sense of danger, attention can also be unstable, switching due to any stimulus.

Depression and anxiety are often hidden behind fatigue and somatic — that is, bodily — symptoms. The majority (61%) of patients complained of shortness of breath, chest pressure, headache, tachycardia, excessive sweating, muscle and joint pain, gastrointestinal tract disorders, and fatigue. In such cases, a person begins to go to doctors of various specialties — gastroenterologists, cardiologists, neurologists. But if the sensations are related specifically to a mental disorder, the cause will not be found either on ultrasound or CT.

"For example, our patient with unexplained pressure surges went almost to the cardiac surgeon, hoping to find a pathology, but it turned out that he had an anxiety disorder, which he did not realize he had — there were only bodily sensations. We started working with his mental state, prescribed therapy, and the symptoms passed," the psychiatrist added.

On average, patients saw a specialist only five months after the onset of symptoms. When such complaints appear, the specialist recommended that physical causes be excluded, but also urged not to delay contacting a psychotherapist or psychiatrist, as the severity of the disorder may increase over time. Since patients are more likely to complain to the doctor about fatigue and somatic manifestations than about bad mood and anxiety, as Golovkina notes, internists, cardiologists and other specialists should carefully consider the mental state of a person who has suffered from COVID-19 and use screening scales and questionnaires to decide whether to refer the patient for a consultation with a psychotherapist. or a psychiatrist."

In addition, Sechenov University recommended taking into account risk factors. In most patients, post-covid-like disorders developed within two months after the virus receded. But there were cases when the infection continued after 10 months. The researchers concluded that the high risk of depression and anxiety disorder persists for about a year.

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It is noted that it increases for a number of reasons. Heredity plays the biggest role. 57% of patients have mental disorders in their relatives in their medical records. Another risk factor is traumatic brain injuries and anesthesia (44%). The chances of developing kidney—related ailments increase in other cases - if the patient had tics, phobias or enuresis in early childhood, if he abuses alcohol and if the course of COVID-19 was prolonged and was accompanied by a lack of sense of smell and taste. At the same time, scientists have not found a link between depression and anxiety with the severity of the coronavirus and the use of various drugs to treat it.

Doctors at Sechenov University have developed and published a treatment plan for postcovoid disorders. It includes drugs with different effects. Medications and their doses are selected depending on the symptoms and individual characteristics of the patient. The study showed the effectiveness of the proposed treatment regimens: within eight weeks of therapy, symptoms were completely relieved in 79% of patients with depression and 77% with anxiety disorders. Golovkina noted that a psychiatrist adds psychotherapy to pharmacotherapy, and if these techniques are ineffective, transcranial stimulation of certain parts of the brain.

Postcovoid disorders in most cases are not related to external circumstances, the scientists concluded. Only 13% of patients had a link between the development of depression and traumatic events such as the death of relatives, dismissal or divorce.

"At the beginning of the pandemic, the increase in cases of depression and other mental disorders was attributed to the stress effects of the pandemic itself and the coronavirus disease. But the further events unfolded, the clearer it became that this was only partially true — the infection itself played a much greater role," the psychiatrist clarified.

She said that, according to various studies, there are several mechanisms of COVID-19's influence on mental health, and they can act in a complex. For example, the so-called cytokine storm, when coronavirus patients have sharply increased levels of various inflammatory cytokines, and it has already been proven that systemic inflammation affects the development of depression. In addition, the virus itself can affect brain cells by penetrating the blood-brain barrier. Vascular disorders and malfunctions of the hypothalamic-pituitary-adrenal system may occur, causing biochemical conditions that contribute to the development of depressive syndromes. An imbalance of key neurotransmitters (serotonin, norepinephrine, dopamine) also contributes to the development of psychiatric disorders, including anxiety and depressive disorders.

The doctor recommended being more attentive to yourself and your loved ones after suffering from COVID-19: a person may not realize the problem, but the sooner they seek help, the better the prognosis will be.

Earlier, on September 15, Deputy of the Russian Academy of Education (RAE), academician of the Russian Academy of Sciences (RAS), epidemiologist Gennady Onishchenko shared that the new strain of coronavirus Stratus, despite its high contagiousness, will not lead to a new pandemic. According to him, the incidence will increase, as well as the incidence of influenza. The specialist stressed that the pandemic has ended, but the virus has continued to spread among people, so you should maintain your health by following preventive measures.

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