Why Long COVID Patients Are Struggling With Depression

Cesar Valesco entered a 51-day coma due to COVID-19 in March 2020. Over a year later, many of his symptoms remain.

Now impaired with long COVID, Valesco experiences back pain, shortness of breath, brain fog, and a never ending cough. He can tolerate his physical symptoms, but it’s the voice in his head that’s unbearable: “You’re useless. You’re no good."

Long COVID patients may experience depression as a result of inflammation in the brain caused by the coronavirus, Peter Staats, MD, medical advisor for Survivor Corps and president of the World Institute of Pain, tells Verywell. He says that it is also natural to experience depression after being “exposed to ICUs and traumatic events associated with critical illness.”

“Part of what makes us human is having a negative affective or emotional response to really negative experiences,” Staats says.

This is true for Valesco, who remembers dark nights in the hospital with people crowding around him and crying.

“The flashbacks [are] really, really, really, hard because I'm a person who is a bit of a fighter,” Valesco tells Verywell. “There are days that I really feel I'm losing to it.”

These flashbacks mingle with guilt, which has ballooned in his continued fight with the virus. His long COVID symptoms make him unable to provide for his family in the way that he once knew. 

“Having a sudden disability had a strong impact on me as a person, as a man of the house, because I cannot work, I cannot help financially,” Valesco says. “It breaks me as a person. It breaks me as a father."

He is thankful for his family, particularly his wife, for supporting him and giving him the strength to keep fighting, he adds.

For both men and women, feeling that they are unable to provide for their family can intensify mental challenges, Staats says. 

“If you aren't the breadwinner that you used to be for the family, that is a normal psychological response to having really adverse events thrown at you,” Staats adds.

How Inflammation Triggers Depression and Fatigue

Long COVID patients who don’t experience flashbacks or guilt can still be prone to depression, Staats says. The COVID-19 virus has an inflammatory impact on every organ system—including the brain, he adds.

Studies show that increased inflammation in the immune system can be associated with depression and fatigue. Researchers have found that people dealing with long COVID have higher levels of inflammation than those with acute COVID.

“The way the brain can manifest inflammation is through things like depression, fatigue, brain fog—several of the areas that we've seen that occur in patients with long COVID,” Staats says.

In some cases, patients with depression and heightened inflammation can be responsive to anti-inflammatory treatments.

Staats serves as the chief medical officer for electroCore, a company that offers a non-invasive vagus nerve stimulation device called gammaCore. The device is currently FDA-approved to treat migraines in long COVID patients. Staats says with more research, it could help treat depression and fatigue, which “may be due in part to inflammation.”

A June study showed that gammaCore reduced fatigue in air force soldiers. More research is needed for gammaCore to be FDA-approved to treat fatigue or mental health problems, but Staats says he is hopeful that investigators will be interested in searching for answers. He adds that vagus nerve stimulation is known to be an extraordinarily safe approach, which could make it a prime candidate for more studies.

Doctors Should Listen and Validate Patient Concerns

When patients are struggling with mental illness, it's important for doctors to offer psychological strategies like cognitive behavioral therapy, Staats says.

Doctors should do this in a way that does not undermine a patient’s long COVID symptoms, but rather validates the multiple challenges, he adds. This is essential as some long COVID patients report that doctors have overlooked their symptoms as anxiety or another mental illness. 

When the medical community has yet to have a clear understanding of a disease, doctors tend to “put up barriers to care for the patient by ignoring them” or not trusting them, Staat adds.

“Patients run the risk of the doctors being wrong and the doctors saying 'It's all in your head,'" he says. “That doesn't mean it's all in your head.”

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.