New advisory links mental health conditions as a symptom of long COVID

Shelisa Loertscher wasn’t expecting to test positive for COVID-19 in March 2023.

Then she thought she would bounce back to normal within a week of testing positive. She had all her vaccinations and boosters and was even prescribed an antiviral medication.

But days turned into weeks, and weeks into months, before she realized she wasn’t getting better.

“I figured I was fine with the virus and just still tired. And it just never went away. So after a month of trying to get back to being normal, I realized it wasn’t getting better,” she said.

Loertscher, like many others, suffers from post-COVID-19 conditions, or long COVID, and while people often experience physical symptoms, such as not being able to taste or smell, some experience mental health symptoms and conditions.

In June, the U.S. Department of Health and Human Services issued an advisory on identifying and managing mental health conditions and symptoms related to long COVID.

According to the advisory, symptoms associated with mental health conditions include depression, anxiety, psychosis, obsessive compulsive disorder, post-traumatic stress disorder, cognitive impairment, sleep disturbances and fatigue.

Dr. Jeanette Brown, medical director of the University of Utah’s long COVID clinic, said studies have found that the virus itself can directly invade nerves in the brain. Essentially, the virus can have a direct effect on nerves in the brain responsible for depression and anxiety.

Brown said there is a lot doctors don’t know about mental health conditions due to long COVID but some studies are showing how viral particles can affect the brain’s nerves.

In fact, one autopsy study showed COVID-19 particles lingered in the brain for almost eight months.

Another study was conducted on hamsters, in which researchers found somatosensory abnormalities in their model.

“They gave them COVID viruses, and they looked and they were able to find viral particles in the nerves but the hamsters responded like they were hypersensitive, like they didn’t like to be touched,” Brown said.

Brown said it’s similar to what they’re hearing from patients with long-COVID symptoms but there are a lot of possibilities.

“It could be a direct response to that nerve being irritated by having viral particles, it could be just the nerve isn’t functioning properly because of that viral infection, or then the question is, is it the immune system that’s recognizing those infected nerves and doing things to the nerve?” she said.

Dr. Dixie Harris, a pulmonary physician at Intermountain Health, said while she mainly treats patients with lung problems, she also screens people for anxiety and depression. Several of her patients are scoring high on the questionnaires.

“A surprising number of my patients will say, ‘I never had anxiety before but ever since I’ve had COVID I definitely feel anxious,’” she said.

Zeb Williams, event coordinator at the Utah Pride Center, has suffered from long-COVID for a couple of years now. Before having COVID-19 in 2020, he was a very active runner and gym goer.

“As the months went by, I just was so tired, so so tired and I couldn’t think. … I got better but then, I just never got better,” he said. “I could never breathe again. I have muscle aches and pain and I couldn’t do a full day of work.”

Williams said one of the biggest mental health struggles was that even though he still looked like the 30-year-old guy who ran and went to the gym, he couldn’t do it anymore.

“Around the six-month mark I started having a different kind of depression set in where I’m like, am I gonna be ... dealing with a disability for the rest of my life, am I going to be dealing with this?”

Another symptom that hindered his ability to work a full day was brain fog.

“Brain fog is weird. It’s just like that feeling of if you’ve ever had a head rush when you stand up too fast, it’s like that just randomly and you’re just like, ‘Wait, what was I saying?’”

Williams isn’t the only one who has experienced brain fog. Harris said several of her patients talk about brain fog and fatigue.

“It really affects your ability to work … where they just have a hard time concentrating. And they get super tired out when they have to do something that requires lots of concentration,” she said.

Williams said he reached a turning point when a nurse practitioner offered him daily treatment and support for his mental health symptoms.

“I was approaching being suicidal because my partner wouldn’t listen to me, my doctor wouldn’t listen to me, my boss wouldn’t listen to me, and finally, someone reached out and just listened to me,” he said.

Loertscher said she’s at a point where she can’t work, or take care of her house or yard, because she doesn’t have the energy to manage it.

“I think with long COVID, and probably any situation where you develop a chronic condition that impacts your life, I think that’s always kind of the perfect conditions for mental health challenges to arise,” she said. “That’s a very depressing setup right there.”

Loertscher said while it’s been a struggle, she’s grateful to still be alive and to have had all her vaccinations because a lot of people didn’t make it through COVID-19.

“I had to think, well, ‘Maybe if I had gotten it before all of the vaccinations and everything, might I have even still been here?’ I don’t know, since it left me with long haul, how much worse could it have been, if I didn’t at least have the vaccinations to kind of blunt the damage?” she said.

Williams said he doesn’t take anything for granted now.

“The biggest thing that it did for me is having such limited energy, and such limited brain power to care about anything, but I’m way more likely to invest in people and things that I love now,” he said. “It’s almost like a near death experience, like surviving a really serious illness. I’m like, ‘I can walk up a hill?’ ‘... Yeah, let’s do it.’ ‘I can play rugby with my boyfriend for a little bit?’ ‘Let’s do it.’”

Williams and Loertscher said people struggling with mental health conditions should not be afraid to reach out for help.

“Ask for help. Show yourself tons of compassion, because it’s real. Know that the illness itself is probably stacking your body up to be a little bit more depressed and anxious,” Williams said.

“You have to reach out and take advantage of everything that’s there to help you get through it because when you don’t, then there’s no way anyone can help you,” Loertscher said.