You’ve recovered from COVID-19 but have lingering headaches. Sometimes your brain feels fuzzy. Other times, you feel anxious or depressed. You could be a COVID “long hauler,” experiencing an array of symptoms--fatigue, shortness of breath, dizziness, sleep disorders, fevers, or gastrointestinal upset--weeks, even months after the illness is over, according to Ethan Hoang MD, Assistant Professor of Clinical Neurology.
Neurological and psychological symptoms, including headache and decreased cognitive ability, are the most common complaints among people with ‘long COVID,’ Dr. Hoang says. “These headaches are like tension headaches. Patients are also reporting trouble concentrating or ‘brain fog,’” he says.
Emerging evidence about the type and severity of cognitive impairments among previously hospitalized COVID-19 patients--especially those who spent time in the ICU--points to difficulties with attention and mental processing speed, as well as memory and executive functioning, says Dora Kanellopoulos, Ph.D., Associate Professor of Psychology in Psychiatry, Attending Psychologist, The Haven, Addiction & Recovery Units, Institute of Geriatric Psychiatry. “Early research suggests that COVID survivors experience difficulties sustaining attention and with memory, planning, and organization, which may contribute to their experience of ‘brain fog’,” Dr. Kanellopoulos explains.
These patients are also more likely than others to have increased risk of anxiety and depression, as well as fatigue and sleep difficulties, Dr. Kanellopoulos says. “Anxiety often begins to develop during hospitalization and worsens in the first three months following discharge,” she says. “In the subsequent three to six-months, anxiety rates decrease slightly but rates of depression increase, as survivors face the chronicity of the changes in their daily lives.
For example, feeling unable to resume physical activities, coping with changes in work or family roles following hospitalization, living in prolonged pandemic-related isolation, or with the fear of reinfection, rehospitalization or further medical complications may all feed anxiety in the months following discharge from the hospital, Dr. Kanellopoulos says.
It is not clear who is at greatest risk for such psychiatric complications, or how long they last, but there are indications that patients with a prior history of psychiatric illness are at greater risk for depression and anxiety following hospitalization, she says.
Moreover, some hospitalized patients who experienced delirium--states of confusion during which they may hallucinate or struggle to distinguish reality--have reported flashbacks of hallucinations months later, which can be frightening and contribute to post-traumatic stress, she adds.
Left unattended, these psychological complications can become chronic and severe. “In some cases, what starts as an acute stress reaction to the events surrounding hospitalization can develop into Post-Traumatic Stress Disorder and may include symptoms such as flashbacks, difficulties sleeping, and avoidance of health-related information and providers as triggers of acute anxiety,” Dr. Kanellopoulos says. Patients experiencing such symptoms may benefit from targeted psychotherapy, involving evidence-based strategies for PTSD, she says.
Since May 2020, WCM has run a free psychotherapy clinic where COVID-19 survivors can receive supportive therapy, cognitive behavioral strategies to reduce anxiety and depression, as well as acceptance- and mindfulness-based strategies, which may help them through the early phases of recovery, Dr. Kanellopoulos says. “These interventions can help improve patient motivation and their ability to engage with physical therapies and medical regimens, which in turn can have a beneficial impact on daily functioning, quality of life, and ability to return to work.”
If you are experiencing neurological or psychological symptoms, please seek evaluation and care. Dr. Hoang urges COVID-19 survivors who have lingering neurological symptoms to see a neurologist for a thorough evaluation. “When a patient presents with neurologic symptoms that they believe is associated with COVID or the vaccine, the neurologist will identify whether these symptoms have features of a known neurologic disease,” he says. “If there are no abnormal findings, then a diagnosis of COVID-related neurologic disease becomes more likely.”
Adds Dr. Kanellopoulos, “We encourage survivors to keep in mind that adjustment difficulties are not only understandable but quite common following acute illness, and that seeking support can significantly improve recovery, engagement in treatment, and quality of life.”