Post-COVID Depression: How Can a General Practitioner Help?
Psychiatrists confirm that mental health plays an increasingly important role in the context of the COVID-19 pandemic. Although exact data will only be available over time, as the impacts in this regard will undoubtedly be long-term, it is already necessary to recognize the correlations between the psyche, the pathophysiology of COVID-19, and the pandemic state of society. What should we be prepared for in the general practitioner's office in this regard, and what therapy is a suitable choice?
The Impact of SARS-CoV-2 on the Human Brain
COVID-19 affects the human brain in two ways: indirectly, through systemic, especially pulmonary effects, leading to hypoxia, a dangerous condition for the brain; and directly, through the development of brain edema. It has been shown that secondary adverse effects of the new coronavirus infection may include cognitive function decline and the development of encephalopathy, delirium, and seizure-like episodes resembling epileptic seizures. The consequences of these processes can, of course, be fatal.
Increased Risk of Mental Disorders
According to available data, about 20% of people who contracted COVID-19 were found to be at risk of anxiety-depressive disorders, insomnia, and the development of dementia. In comparison with data from 2017, there is now a threefold occurrence of major depressions, and suicide cases have also increased. Meta-analyses of long-term clinical outcomes based on studies of other respiratory viruses causing severe diseases reveal that in patients who survived acute respiratory syndrome, the prevalence of depression was 33% and anxiety 30%, lasting more than six months after hospitalization.
COVID-19 as a Depression Breeding Ground
The situation surrounding the COVID-19 pandemic acts as a strong depressant, significantly reinforced by its daily media portrayal. Increased unavoidable exposure to negative stimuli, combined with restrictive measures, acts as a significant stress factor, creating an environment conducive to anxiety and depression. Home isolation is also associated with increased home alcohol consumption and incidents of domestic violence.
Activation of the stress axis generally results from psychosocial stress, frustration, and isolation, but also from reduced sleep duration and disruption of daily routines when transitioning to remote work (home office).
Stress During the Pandemic: What to Advise Patients
1. Motivate Adherence to Treatment Regimens
Patients already on antidepressants should be advised to stick to their established treatment plans. For those who have newly prescribed medication, we should motivate adherence. Suitable questions include: “How are you managing the new treatment?” “How do you perceive the reasons for taking these medications?”
2. Remind Them That This Is a Temporary Situation
Even though the COVID-19 pandemic seems endless, it is good to remind patients that it is a severe but likely temporary situation that will eventually end. Remind your patients that history shows similar situations that subsequently subsided.
3. Advise Patients to Try to Eliminate Other Stress Factors
Experts recommend that people forced to change their routines create daily routines and rituals, take care of themselves, and stay connected with friends and family through phone calls. It is also advisable to limit media exposure.
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Sources:
1. Höschl C. Communication with patients during COVID times. Webinar for general practitioners. Praktickylekar.online, 26. 11. 2020. Available at: www.praktickylekar.online/eoLPC0dpIXg
2. Tucker P., Czapla C. S. Post-COVID stress disorder: another emerging consequence of the global pandemic. Psychiatric Times 2021; 38 (1). Available at: www.psychiatrictimes.com/view/post-covid-stress-disorder-emerging-consequence-global-pandemic
3. Depression & managing stress during the COVID-19 pandemic. University of Michigan, 2021. Available at: https://medicine.umich.edu/dept/psychiatry/michigan-psychiatry-resources-covid-19/specific-mental-health-conditions/depression-managing-stress-during-covid-19-pandemic
4. Hamed M. G. M., Hagag R. S. The possible immunoregulatory and anti-inflammatory effects of selective serotonin reuptake inhibitors in coronavirus disease patients. Med Hypotheses 2020 Nov; 144: 110140, doi: 10.1016/j.mehy.2020.110140.
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