Nearly 1 in 5 COVID-19 patients experience these conditions within 90 days post-recovery

INDIANAPOLIS (WISH) — Former coronavirus patients experience anxiety, depression and insomnia within 3 months post-recovery, according to a new study.

News 8 spoke with Dr. Heather Fretwell, psychiatrist at Eskenazi Health, about why this might be happening and the mechanisms behind the change in brain function which lead to these conditions.  

Gillis: We have this report that just came out indicating that COVID-19 patients have been diagnosed with a mental disorder. This isn’t always immediate. The scientists found the onset can occur as soon as 2 weeks to up to 90 days post-recovery. And these are individuals that have not necessarily been previously diagnosed or suffered from a mental health disorder such as anxiety or depression. What are your thoughts on why this is happening especially in those folks who haven’t experienced these mental health issues before? 

Fretwell: These are great questions. This is a pretty complex study. It was conducted in the United Kingdom using data from the United States so it’s very pertinent to our world today. They reviewed the records of 69 million patients including 60 some thousands of whom were COVID-19 positive. From that, you can see in that period from about 2 weeks to 3 months after COVID-19 symptoms that about 18 percent of people went to their primary care doctor or to an in-network secondary doctor such as a psychiatrist or a therapist and were with diagnosed with a recurrent or new onset of a mental health condition. 

Of the persons with new onset, that was about 5 percent of the total, which is more than folks who didn’t have COVID-19 in the same interim. They had instances of a mental health condition of about 2 to 3 percent in that time period. So, having COVID-19 appears to increase our risk for a new mental health condition, particularly anxiety and mood disorders by about double compared to people who do not have COVID-19 in that same time period by the authors. 

And so it tends to reactive if you’ve had prior mental health conditions. Maybe they’ve been treated or maybe they’ve been dormant. Either way it tends to reactivate the mental health conditions we may have struggled with in the past. 

Gillis: Authors also point to insomnia as a side effect of COVID-19 post-recovery during this same time-frame. Does insomnia fall into a category of a mental health issue or is this just a sign that we’re stressed?

Fretwell: This is a fascinating question and really leads into an intricate account of how our bodies respond to viruses and how our bodies respond to stress. One of the pieces that is not well known is that melatonin is actually in our bodies and is something that helps our 24-hour cycle and enhances the effect of mitochondria in our immune system. So, when our melatonin is good it boosts our immune system function. 

The most successful viruses of mankind such as the flu viruses and now COVID-19 have in their inflammation and their attack on the body also disrupt melatonin production and so in this way these viruses seek to weaken our immune system and decrease our ability to fight it off. 

Not only does this weaken our immune system, but it disrupts our melatonin production and our normal 24-hour circadian rhythm cycle. This also tends to lead to insomnia, a sleep shift disorder and scattered naps and  sleep and this overall feeling of the body that it doesn’t know if it’s coming or going because this rhythm isn’t being able to be executed in it’s normal fashion. 

So people tend to be tired. They don’t sleep well even well after the resolution of the COVID-19 symptoms. It can take a long time to normalize. 

Gillis: And why did the authors decide to study the range. Two weeks though 3 months post COVID-19 recovery. I was thinking…there are physiological effects as a result of this virus that are going to continue in the aftermath. But are people just now coming to terms with what has happened to them 3 months post-recovery?

Fretwell: So, the authors selected this particular time range in large part to eliminate the acute effects of COVID-19. So, by choosing to start two weeks after the COVID-19 symptoms they were trying to eliminate the, perhaps, any symptoms or psychiatric or otherwise symptoms that would be part of the actual COVID-19 acute infection. They were much more interested in looking at the post COVID-19 period, which they defined in the study as 2 weeks to 3 months 

Upcoming studies as they are made available will extend that time frame. This is considered a fairly near experience in terms of a stressor perhaps resulting in a new case or in a new ailment or in different kinds of problems in terms of what a person might have. So, it’s a fairly logical time-frame.

But I would say probably the range–in terms of what you were talking about–this is persisting, this is going on for a month, this is going on for 2 months…and saying okay I do really need to go get help now. Compared to other people’s range of experience they may have had a worse case or a more severe set of symptoms might prompt earlier treatment. 

In the study, there wasn’t a whole lot of difference that they could tell between folks that needed to be hospitalized for COVID-19 versus those who were able to manage their COVID-19 symptoms while at home. 

A piece that is still in the works in terms of being able to see if there is an association or not between COVID-19 and PTSD (Post Traumatic Stress Disorder) because we literally don’t have enough data over a 6-month time frame which is required for a PTSD diagnosis. 

Gillis: And any other thoughts you might have for our Hoosiers? People who might be suffering from this?

Fretwell: Well, I do want to mention something that we can all be very proud of is that some of this relationship between the immune system and the immune system that’s leading to some of symptoms…some of the earliest research has been right here at our IU School of Medicine that discovered that we have actual nerve endings into our lymph nodes and we have really these sophisticated feedback loops between our immune system and all the storms we might go through with an infection and our nervous system, which is trying really hard to stay regulated during that same time period.

So, we can be really proud of our researchers here at home and we can know that science everywhere is trying to advance our knowledge so that we can look at questions such as if melatonin is disrupted will taking supplemental melatonin be helpful perhaps be helpful in terms of some sort of treatment. We don’t know yet, but we are looking very hard to try to find more answers. 

Gillis: Yes, there have been so many contributions coming from the state of Indiana. Our hospitals, our medical centers and, of course, Eskenazi Health. Dr. Fretwell, thank you so much for being with us. 

News 8’s medical reporter, Dr. Mary Elizabeth Gillis, D.Ed., is a classically trained medical physiologist and biobehavioral research scientist. She has been a health, medical and science reporter for over 5 years. Her work has been featured in national media outlets. You can follow her on Instagram @reportergillis and Facebook @DrMaryGillis.