Mental Health During the Pandemic − and How to Alleviate Its Impacts
At the symposium during the XV Spring Interactive Conference of the General Medical Society of ČLS JEP, which was eventually held in September 2021 in Prague, Prof. MUDr. Cyril Höschl, DrSc., FRCPsych, presented his lecture on the impacts of the COVID-19 pandemic on mental health. At the end of his speech, he also addressed the practical issue of selecting a suitable antidepressant.
How the Prevalence of Mental Disorders Changed During the Pandemic
At the beginning, Professor Höschl focused on the question of whether the prevalence of mental disorders changed as a result of the COVID-19 pandemic. The results of a Czech study comparing data from November 2017 and May 2020 showed that the incidence of any mental disorder in the population increased from 20% to 30%, major depression tripled, suicidal thoughts also tripled, and anxiety disorders doubled. The findings of the study are practically confirmed by the massive increase in the workload of crisis hotlines, often by hundreds of percent.
Other analyses indicate that, specifically among healthcare workers, mental disorders appeared more frequently than in other professions. Disproportionate impact was also recorded among young adults, students, people who lost their jobs, the unemployed, and those with basic education.
COVID-19 and Mental Health
“COVID-19 is related to mental health both biologically − through hypoxia that damages the brain, and directly by affecting the brain, causing encephalopathy. This can clinically manifest as delirium, depression, cognitive disorders, or even epileptiform seizures,” explained the lecturer. Throughout the pandemic, other significant stressors such as “media bombardment,” isolation, frustration, domestic violence, or the loss of a loved one also impact mental health. These stressors can lead to depression, anxiety, and suicidal thoughts. Increased alcohol consumption and disruption of chronobiology due to changes in daily routine and sleep inversions also contribute to the development of depression. Insomnia, depression, and anxiety also appear as part of the post-COVID syndrome.
Interesting conclusions come from a 2020 study showing that COVID-19 is associated with a higher risk of developing a mental disorder 14−90 days after diagnosis. Conversely, individuals with mental disorders have a higher tendency to contract COVID-19 (relative risk 1.65). After recovering from COVID-19, the risk of developing a mental illness is about 20%.
How to Choose a Suitable Antidepressant
According to Professor Höschl, it is important to match the patient's profile with potential antidepressant treatment. “We choose an antidepressant based on its effectiveness, the speed of onset, its tolerability, minimal side effects, and in many patients, it should also work on anxiety so that we kill two birds with one stone. Depression is often associated with insomnia, so we want the antidepressant to have a beneficial effect on sleep. Last but not least, it should have as few interactions as possible when combined with other medications,” Professor Höschl listed.
He concluded his lecture with a discussion on trazodone, which beneficially affects various receptors − it stimulates 5-HT1A receptors, ensuring an antidepressant effect, and blocks 5-HT2A and 5-HT2C receptors, hence not causing sexual dysfunction, positively influencing sleep, and reducing anxiety. Its significant antidepressant effect is primarily ensured by the simultaneous blockade of the serotonin transporter, α2 receptors, and 5-HT2C receptors.
Proper dosing of trazodone is crucial. 1 mg has very mild hypnotic effects, 50 mg has hypnotic, anxiolytic, and calming effects. Only at a dosage of 300 mg, with nearly 100% receptor occupancy, is the full therapeutic spectrum, including the antidepressant effect, achieved.
Trazodone demonstrates a rapid onset of action comparable to venlafaxine. Since trazodone does not suppress the activity of dopaminergic neurons in the anterior tegmental area, there is no emotional flattening or reduced response to rewards. Administering the extended-release form in relatively high doses reduces the hypnotic effect, eliminates daytime drowsiness, and enhances the antidepressant effect, positioning trazodone as a first-line antidepressant therapy option.
(vef)
Source: Höschl C. The Impact of COVID-19 on Mental Health. XV Spring Interactive Conference SVL ČLS JEP, Prague, September 3, 2021. Available at: www.youtube.com/watch?v=7CGIeymUTPg
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