Anxiety, Your Brain, and Long COVID: What the Research Says

June 2, 2023 — Anxiety, depression, and COVID-19 can be a bad combination for your brain — and your long-term health.

Having anxiety and depression for a COVID infection increases the risk of developing long-term COVID, researchers have found.

Those with long COVID developing anxiety and depression after may have an infection brain shrinkage in areas that regulate memory, emotion and other functions, as well as disruption of brain connectivity.

While many questions remain about these intertwined relationships, the associations come as no complete surprise. Experts already know that depression and anxiety are associated with inflammation and immune dysfunction, perhaps helping to explain the link between these mental illnesses, the risk of long-term COVID, and the changes in the brain.

Brain changes associated with COVID infection have been troubling researchers since earlier in the pandemic, when researchers at the UK Biobank found it brain atrophy, gray matter loss, and cognitive decline in those infected with COVID compared to those uninfected.

Common Terms

The researchers evaluated data from three large, ongoing studies involving nearly 55,000 participants to determine the effects of high levels of psychological distress prior to COVID infection.

“Our research was based purely on surveys,” said Siwen Wang, MD, the study’s lead author and a research fellow at Harvard’s TH Chan School of Public Health at Harvard University.

At the start of the study in April 2020, none of the participants reported a current or previous COVID infection. They answered surveys about psychological distress at the start of the study, at 6 monthly intervals, then quarterly until November 2021.

During follow-up, 3,193 people reported a positive COVID test and 43% of them, or 1,403, developed long-term COVID. That number may seem high, but 38% of the 55,000 were active health workers. On the final questionnaire, they reported whether their symptoms persisted for 4 weeks or more and thus had long COVID by the standard CDC definition.

In one of her studies, presented at the April 2023 meeting of the American Academy of Neurology, she found brain changes in people with anxiety, depression and COVID, but not in those infected who had neither mental health problem. She evaluated 254 people, median age 41, about 82 days after their positive PCR test for COVID. Everyone completed one standard questionnaire for depression (the Beck Depression Inventory) and another for anxiety (the Beck Anxiety Inventory). She further divided them into two groups: the 102 with symptoms and the 152 who had no symptoms of depression or anxiety.

Brain scans showed that those with COVID who also had anxiety and depression had shrinkage in the limbic area of ​​the brain (which helps with emotion processing and memory), while those who were infected and did not have anxiety or depression did not . The researchers then scanned the brains of 148 healthy people without COVID and found no shrinkage.

The atrophy, Yasuda said, “isn’t something you can see with your eyes. It was only detected with computer analysis. Visualization on an MRI is normal.”

Another, less common hypothesis, she said, is that “people with long-term COVID have more autoantibodies and are more likely to have blood clotting problems. These have also been found in people with anxiety, depression or other mental health problems.”

Other researchers are looking more broadly at how COVID infections affect the brain. When German researchers evaluated the brains and other body parts of 20 patients who died of non-COVID causes but had documented COVID infections, they found that 12 accumulations of the SARS-CoV-2 spike protein in the brain tissue and in the skull and meninges, the membranes that line the skull and spinal cord. Not healthy controls.

The findings suggest that the persistence of the spike protein may contribute to the long-term neurological symptoms of long-term COVID and may also lead to an understanding of the molecular mechanisms and therapies for long-term COVID, the researchers said in their preprint report, which has not been published. not yet peer-reviewed.

In another recent study, researchers from Hamburg, Germany, performed neuroimaging and neuropsychological assessments on 223 people who had not been vaccinated and were recovering from mild to moderate COVID infections, comparing them to 223 matched healthy controls who had undergone the same tests. In those who were infected, they found changes in cerebral white matter, but no worse cognitive function in the first year after recovery. They conclude that the infection triggers a long-lasting neuroinflammatory response.

The habits include: a healthy BMI (18.5 to 24.9), never smoking, at least 150 minutes a week of moderate to vigorous physical activity, moderate alcohol intake (5-15 grams per day), high quality nutrition and good sleep (7- 9 hours a night).

Long term solutions

Yasuda hopes that mental health care – of those who are infected and those who are not – will be taken more seriously. In her commentary of her own long COVID experience, she wrote in part, “I fear for the numerous survivors of COVID-19 who are unable to access medical care for their post-COVID symptoms. … Mental health services must be prepared to receive survivors with various neuropsychiatric symptoms, including anxiety and depression.”