Study: Anxiety among aftereffects of COVID
Nearly one-fourth of patients develop anxiety, a mood disorder such as depression or a psychotic condition six months after having COVID-19, among a number of long-lasting aftereffects of the disease, according to a new study reported in The Lancet medical journal.
Substance use disorder and insomnia also were reported in some patients, as well as bleeding in the brain and strokes.
However, factors not directly related to the infection itself, such as isolation from family and friends, job loss and a death in the family, as well as health conditions such as obesity, diabetes and high blood pressure, also play a role in neurological diseases, according to Dr. Sharon Stoll, a neurologist with Yale Medicine who specializes in the study of the immune system.
“I agree with that hypothesis: Post-COVID is the trigger for the onset and persistence of the neurological and psychiatric diseases mentioned in the article,” Stoll said Wednesday. But what needs further study is “how much do confounding factors increase either the severity [or] the duration of the diseases.”
“Would it have resolved after six months if not for everything else?” she said, or is it possible the disorder would not be as severe if not for social and other health factors.
Stoll pointed out that patients who were not hospitalized developed neurological symptoms that lasted for months, adding to the urgency for people to get vaccinated, even if they do not believe they are at risk for a serious case of COVID.
The researchers looked at electronic health records for 236,379 COVID patients and found more than one-third had a neurological or psychiatric diagnosis in the next six months.
“Since the COVID-19 pandemic began on March 11, 2020, there has been concern that survivors might be at an increased risk of neurological disorders,” begins the article. “Similar concerns have been raised regarding psychiatric sequelae of COVID-19, with evidence showing that survivors are indeed at increased risk of mood and anxiety disorders in the three months after infection.
“However, we need large scale, robust, and longer term data to properly identify and quantify the consequences of the COVID-19 pandemic on brain health. Such information is required both to plan services and identify research priorities,” the article states.
Patients who required hospitalization were more likely to acquire a postCOVID disorder than those who did not, and those who required intensive care were the most likely, the article states. It says “potential mechanisms for this association” include the virus’ effect on the central nervous system, the potential for blood-clotting and the effect on the nervous system of the body’s immune response.
“COVID is definitely a factor” in developing anxiety and mood disorders, psychosis, substance use disorders, insomnia and other conditions, Stoll said, “but we also have to consider isolation, decreased work, working from home, lack of social interaction as part of that picture as well.”
For people who are susceptible to neurological issues, COVID may be “the straw that broke the camel’s back or may be the brick that broke the camel’s back. COVID plays a role,” she said.
When looking at increased incidences of stroke, psychiatric disorders, insomnia and other problems, “the rate is too high post-COVID for there not to be an association with the virus, but the question is what percentage do the other factors play in it?” Stoll said. “What factor does isolation, social distancing, loss of a job or loss of work play into it?”
A stroke is often caused by high blood pressure, but COVID will increase the risk, she said. “Every scientist is used to looking into these mitigating factors. … Nothing is studied in isolation,” Stoll said.
“As a scientist at heart, it would be interesting to have a study that separates or matches the confounding factors” to isolate the effect of COVID itself, she said.
Stoll said she was surprised the study did not examine typical long-term symptoms of post-COVID patients, such as chronic fatigue syndrome, headaches, brain fog and muscle aches “that can persist several months after a viral illness,” including Epstein-Barre virus and Lyme disease. However, “we’re definitely seeing much more of that after COVID than other illnesses,” she said.
That could be because “when somebody has the flu or somebody has other infections, the world doesn’t shut down … you’re not isolated for months on end” and required to wear a mask in public, Stoll said.
The study also compared the rates of disease of COVID patients with patients who had influenza or other respiratory tract illnesses and found COVID patients were more likely to suffer from almost all the measured neurological conditions, including stroke, brain bleeds, encephalitis and dementia.
“It doesn’t seem like the COVID virus is really entering the brain, but there does seem to be some central nervous system … effect,” Stoll said. “It’s very much a mystery.”
edward.stannard@ hearstmediact.com; 203-680-9382