Mental Health and Long COVID

What we know, how integrative psychiatry can help, and how to navigate long or long haul COVID symptoms.

Do You Have Long COVID?

If you're like the majority of Americans, you have already contracted COVID-19. Some people get very sick, some get mildly ill, and then some people don't even have any symptoms. What does the timeline look like if you're still feeling lousy for what seems like longer than you should be?

People who didn't have any symptoms with COVID may still be at risk for Long COVID, but it appears that they are likely at a lower risk than those who have had symptoms. Being hospitalized for COVID increases your risk of developing long COVID - more than half of those who have been hospitalized for COVID continue to experience symptoms for up to 3 months.

Possible Long COVID Symptoms

People with long COVID often have multiple symptoms - in multiple organ systems. There is some overlap in this presentation with other complex health conditions, such as other post-viral infections, chronic fatigue syndrome, chronic lyme and other tick-borne infections, and fibromyalgia - a one size fits all plan is not going to work. A symptom --> diagnosis --> treatment model is not going to work. While we are still understanding the longterm effects of COVID, post-viral symptoms are not new. What are the possible symptoms of long COVID?

Brain: Brain fog, dizziness, loss of attention, confusion, inability to smell/taste, anxiety, depression, insomnia, panic, flashbacks
Heart: Chest pain, palpitations, fast heartbeat
GI system: Nausea, vomiting, diarrhea, stomach pain
Respiratory: General fatigue, cough, difficulty breathing
Musculoskeletal: Joint pain, muscle soreness

Why Inflammation is Likely Playing a Major Role

Viral infections can cause inflammatory states in our body and impact our bodies' stress response system. When there is chronic inflammation in the nervous system, a consequence can be a vague constellation of symptoms, such as fatigue and brain fog. Viruses and bacteria can be really sneaky and hide out in cell structures, such as mitochondria, which are what create energy in our cells, and can also hide in the gut microbiome. When the gut microbiome is mucked around with or if our mitochondria aren't functioning properly, the downstream effects of inflammation and immune system dysfunction can lead to mental health symptoms, such as depression and anxiety. Decreasing inflammation and understanding what inflammatory pathways that are out of control need to first be addressed.

Strategies for Treating Long COVID

Harmonize the gut microbiome.

Nutrition is crucial - and either can harm or heal. Eating a diet with processed foods and sugars increase inflammation and a Mediterranean diet is anti-inflammatory.

Focus on eating plant-based foods high in dietary fiber. Dietary fiber from plant foods can be fermented by bacteria as an energy source, which can improve the gut barrier and improve the immune system. An elimination diet may be necessary.

Eat fermented food such as yogurt, kefir (kind of like a liquid yogurt), kimchi, and sauerkraut. The healthy bacteria in these foods can boost the immune system and increase diversity in the gut microbiome, which can lead to decreased inflammation and mental health symptoms. Spices and herbs like turmeric (the deep yellow spice found in curries and golden milk), and green tea can also decrease inflammation and regenerate the immune system.

Supplement with Vitamin D.

Work with a healthcare practitioner to get your Vitamin D levels checked via lab work. Vitamin D supplementation has consistently been shown to decrease inflammation in the body.

The daily amount recommended to take will depend on your current level of Vitamin D via lab testing. Aim for a Vitamin D level between 50-90 ng/mL.

Optimize sleep.

Sleeping well is essential for your body to heal and lower inflammation. There are lots of reasons why people sleep poorly. Some ways to improve your sleep include adjusting your sleep environment. Keep all phones out of your bedroom, implement a "no phone use after 8pm rule", and keep your bedroom temperature on the cooler side. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a better option than sleeping medications and even is available as an app, such as FDA-approved Somyrst or CBT-I coach.

A popular over-the-counter sleep supplement and sleep hormone, melatonin, is thought to be anti-inflammatory and may help regulate sleep-wake cycles. Dose recommendation is typically 1 mg at night. There are many other herbal and non-pharmaceutical options that may help with sleep as well such as magnesium glycinate, lemon balm, passionflower, chamomile tea, valerian root, and L-theanine.

Exercise

Try to start with heart rate training or even heart rate training with infrared sauna use, if formal movement-based exercise is not possible. Exercise can be very challenging for people recovering from COVID but is a necessary pillar for becoming well again.

Stress Management and Emotions

Navigating stress and healing emotional pain help lower inflammation and improve immune functioning. Part of this is giving ourselves property space and time to heal. Meditation can help balance the nervous system and connect us to our inner peace and deepest wisdom. Simplify as much as possible. Make a list of your daily responsibilities and see what you can take off of your list. What can wait, get delegated, or just not get done? It's easy to get down on ourselves when we aren't feeling good, but now is the time to practice caring for yourself and being gentle on yourself.

As an integrative psychiatrist, my goal is to help people build health. We are still learning so much about long COVID. But we need to utilize individualized treatments that focuses on reducing inflammation and improving mitochondrial functioning so people with long COVID can start feeling better.

References:

Erten Uyumaz, B., Feijs, L., & Hu, J. (2021). A review of digital cognitive behavioral therapy for insomnia (CBT-I Apps): are they designed for engagement?. International journal of environmental research and public health, 18(6), 2929. https://doi.org/10.3390/ijerph18062929

Fernández-de-las-Peñas, C., Palacios-Ceña, D.; Gómez-Mayordomo, V., Cuadrado, M.L., Florencio, L.L.(2021). Defining post-covid symptoms (post-acute covid, long covid, persistent post-covid): an integrative classification. Int. J. Environ. Res. Public Health,18(5), 2621. https://doi.org/10.3390/ijerph18052621

Knight, R., Parfrey, L.W., Ursell, L.K., Clemente, J.C. (2012). The impact of the gut microbiota on human health: an integrative view. Cell148(6), 1258-1270. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5050011/

Neurath, M., Uberla, K., Ng, S.C. (2022). Gut as viral reservoir: lessons from gut viromes, HIV, and covid-19. BMJ Gut(70), 1605-1608. https://gut.bmj.com/content/70/9/1605

Stefano, G., Puttiker, P., Weissenberger, S., et al. (2021). Editorial: the pathogenesis of long-term neuropsychiatric covid-19 and the role of microglia, mitochondria, and persistent neuroinflammation: a hypothesis. Med Sci Monit, 27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120907/

Yong, S.J. (2021). Long COVID or post-covid-19 syndrome: putative pathophysiology, risk factors, and treatments. Infectious Diseases, 53(10), 737-754. https://www.tandfonline.com/doi/full/10.1080/23744235.2021.1924397

The information and any products mentioned in this article are not intended to diagnose, treat, cure, or prevent any disease. The information provided is for educational purposes only and not intended to replace the relationships with your physician(s). Before initiating any conventional or integrative treatments, please first consult with a licensed medical provider. Please review references provided at the end of article for scientific support of any claims made.