Depression after COVID-19: What is the link?

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Researchers do not know if COVID-19 directly causes depression. However, there may be a relationship between the two.

COVID-19 is an illness that occurs due to the virus SARS-CoV-2. Although it is a virus that spreads through droplets from the respiratory system, such as via coughs and sneezes, the symptoms can affect many parts of the body.

For some, the symptoms are mild and go away on their own. Other people develop long-term symptoms, known as long COVID.

Most people who recover from COVID-19, including those with severe symptoms, do not develop depression afterward. However, several studies have found clinically significant depression rates in those who have survived COVID-19.

For example, a 2021 systematic review of eight prior studies found that 12 weeks after COVID infection, 11–28% of people had depression symptoms. In 3–12% of people, symptoms were severe.

This suggests that having COVID-19 may make depression more likely, but studies have not proven that COVID-19 itself directly causes it, and they have not revealed why some people develop depression while others do not.

People experiencing long COVID may also experience neurological symptoms, including depression.

There are several ways in which COVID-19 may contribute to depression, both on a biological and psychological level.

Biological changes

COVID-19 can cause neurological changes in some people. The loss of a sense of smell some people experience is an example of a COVID-19-related neurological change. Scientists are still learning how this occurs, but it may relate to instances of depression, too.

A 2020 study of COVID-19 survivors with depression also suggests that higher levels of inflammation at the time of diagnosis correlate with a higher risk of developing depression. Inflammatory processes may play a role in depression.

However, the study also notes that females have lower baseline inflammation than males but higher overall depression rates after COVID-19. This suggests that inflammation alone cannot explain the increase in depression rates.

Symptom severity and hospitalization

The 2020 study also found that requiring hospitalization due to COVID-19, and having to stay in hospital for longer, also correlated with higher depression rates.

The researchers found that 31% of 402 COVID-19 survivors had depression symptoms 1 month after being in hospital due to COVID-19.

These findings fit with previous research on depression in people who have had to stay in intensive care units (ICUs). In one study in Jordan, eight in 10 of the 105 patients who had left ICUs had depression. This symptom can be part of a condition that doctors call post-intensive care syndrome.

Pandemic-related stress

A 2020 study suggests that it is not just COVID-19 itself but also the experience of living through a pandemic that may increase the risk of depression.

The study, which looked at people living in Ireland, identified the following risk factors for depression during the COVID-19 pandemic:

• younger age
• being female
• higher perceived risk of catching COVID-19
• loss of income because of COVID-19
• history of COVID-19 infection

This suggests that a person’s fear of COVID-19, as well as their position in society, influenced how likely they were to develop depression.

According to a scientific brief by the World Health Organization (WHO), the first year of the COVID-19 pandemic triggered a 25% worldwide increase in depression. The WHO also highlights that young people, women, and people with pre-existing health conditions were disproportionately affected by the stress of the pandemic.

Learn more about depression symptoms and causes in women here.

In addition to contributing to new cases of depression, COVID-19 appears to be more likely to worsen or trigger symptoms for those who have experienced depression before.

This is also true for people who have not had the illness itself but have experienced stress or anxiety because of it. A 2020 study found that higher perceived risk of getting sick and COVID-19-related job losses both correlated with a higher risk of depression among a representative sample of people in Ireland.

Global events such as pandemics can include many of the risk factors that may trigger depression symptoms, including:

• significant change and uncertainty
• the potential for traumatic experiences
• multiple chronic sources of stress

As a result, people with a personal or family history of depression may be more vulnerable to the psychological impact of COVID-19 than others.

A number of studies have found that the COVID-19 pandemic increased rates of depression worldwide.

This increase did not only relate to the first few waves of COVID-19. A 2022 study of seven European countries found high rates of depression during various COVID-19 waves, with about 1 in 4 people experiencing depression during the fourth wave of the pandemic.

Prevalence of depression was especially high among certain groups. For example, a 2022 systematic review and meta-analysis found a pooled prevalence rate among doctors of 20.5% during the pandemic’s first year. Doctors and other healthcare professionals faced high rates of trauma and COVID-19 exposure.

Anyone who thinks they may have depression, whether or not they have had COVID-19, should seek help. Some signs a person may need help include:

• feeling very sad
• feeling hopeless, or that things cannot ever get better
• loss of pleasure from activities they previously enjoyed
• thoughts of self-harm or suicide

A person should also seek help if they continue to experience COVID-19 symptoms several weeks after recovering or testing negative.

The treatment for depression can include a combination of therapy, medications, and coping techniques that a person can use to ease symptoms. However, during a pandemic or lockdown, it may be more difficult to access this care.

There are ways that healthcare services have adapted to this. Instead of attending in-person therapy or a doctor’s appointment, a person may be able to access:

• online or virtual therapy, either via video conference with a therapist or through an online therapy platform
• online support groups for people with depression, long COVID, or both
• automated refill prescriptions or medication delivery services

Depression is a real and potentially serious illness that a person cannot treat themselves. However, there are measures people can take to care for themselves while waiting for medical treatment.

Some self-care strategies at home include:

• regularly spending time outside in gardens or green spaces
• using home exercise equipment or video classes to boost mental and physical health
• finding ways to connect with loved ones, even if a person cannot see them in-person
• eating regular meals and drinking enough water
• following a relaxing bedtime routine and practicing sleep hygiene for better sleep
• scheduling time each day for any activities a person does find pleasurable

It may help to create a daily routine that includes some of these self-care activities. A person can start by introducing one of them, then work towards others.

However, it is important to note that if a person has long COVID, exercise can make symptoms worse. They should speak with a doctor about managing energy levels.

Learn more about behavioral activation for depression here.

The relationship between COVID-19 and depression is complex. Life during a pandemic can be scary and stressful, which may increase the risk of depression.

Exposure to COVID-19 can exacerbate that risk, either because of the traumatic nature of living through a pandemic, neurological changes from the disease, or other processes that doctors have not yet identified.

The right combination of therapy, medication, and lifestyle changes can help people feel better and start to learn healthy coping skills. People who think they have depression, regardless of the reason, should speak with a doctor or mental health professional.