Understanding the long-term cognitive and psychiatric effects of COVID-19: a closer look

For some, the journey of recovery from COVID-19 is marked by lingering post-COVID mental health problems and cognitive conditions that can persist for years. Long COVID is an often-debilitating condition, affecting at least 10% of those infected with SARS-CoV-2, and over 200 symptoms have been identified across multiple systems within the body¹. Many of these symptoms, including new onset myalgic encephalomyelitis/chronic fatigue syndrome and dysautonomia, are anticipated to be lifelong².

But symptoms such as cognitive decline after COVID-19 can have profound long-term effects on daily life. A number of individuals continue to experience these symptoms two to three years post-infection³, with psychiatric conditions post-COVID such as depression, anxiety, and cognitive decline becoming more prevalent⁴. Research from Mind found that about a third of adults and young people reported a significant deterioration in their mental health since March 2020⁴, highlighting the widespread post-COVID mental health problems many continue to face.

A recent study by the University of Oxford⁵ offers valuable insight into this issue. The research found that cognitive and psychiatric symptoms remain prominent two to three years after infection, with participants scoring significantly lower on cognitive tests and reporting severe depression and anxiety. This study underscores the importance of addressing the long-term cognitive decline after COVID-19, contributing to our understanding of its lasting impact on mental health.

Cognitive deficits after COVID-19 infection: understanding the long-term impact

The COVID-19 cognitive decline that was identified in recent research has drawn attention to the serious long-term effects of the virus on brain function. According to the University of Oxford study, individuals who had been hospitalised due to COVID-19 scored, on average, 10 IQ points lower on cognitive tests two to three years after infection⁵. This decline in memory problems after COVID-19 and attention deficits can severely impact day-to-day functioning, making simple tasks more challenging for many people.

Among the most common cognitive symptoms are difficulties with post-COVID attention deficit, memory loss, and a phenomenon commonly referred to as long-term COVID brain fog. Studies indicate that neurological and cognitive symptoms are key features of long COVID, with issues such as memory loss, cognitive impairment, and autonomic dysfunction affecting daily activities^1,6. Research has found that cognitive impairment affects up to 26% of patients 12 months after infection⁷. Fatigue and cognitive impairments, such as difficulties concentrating, are still present in a significant proportion of people well beyond the acute phase of their illness⁸.

While the underlying mechanisms for these impairments are still being investigated, it is thought that neuroinflammation, coagulopathy, and endothelial dysfunction may contribute⁹. Additionally, some have linked these impairments to changes in brain structure, such as reductions in grey matter thickness¹⁰. Alarmingly, many people may not fully recognise the severity of cognitive decline – if at all¹¹, underscoring the importance of early intervention to prevent further deterioration and to closely monitor cognitive symptoms in post-COVID patients.

Moreover, while mental health conditions such as anxiety and depression have been shown to return to normal levels over time, the risks of cognitive impairment, seizures, dementia, psychosis, and other neurocognitive conditions can persist for at least two years following COVID-19 infection¹². These findings highlight the importance of addressing and managing cognitive symptoms in the long term.

Psychiatric effects of COVID-19: depression, anxiety, and fatigue

The psychiatric effects of COVID-19 are increasingly recognised as serious long-term consequences of the virus¹³. According to recent research, depression, anxiety, and fatigue persist in a significant proportion of individuals two to three years after their initial infection. The Oxford study found that one in five people reported severe depression, one in eight experienced anxiety, and one in four struggled with chronic fatigue⁵. These long COVID mental health issues have become critical areas of concern, especially as they continue to affect daily life for so many individuals.

A relatively new concept, the “physio-affective phenome of acute and long COVID,” has emerged to describe the combination of COVID-19 fatigue syndrome and affective symptoms like depression and anxiety¹³. The severity of these symptoms is linked to the body’s response during the acute phase of the illness, such as high fever and low oxygen saturation, and is believed to be driven by the disease’s impact on neuro-immune and oxidative pathways¹³. This pathophysiology aligns with conditions like chronic fatigue syndrome, major depression, and generalised anxiety disorder, where inflammation and neurotoxicity play key roles^14-16.

One study investigating psychiatric symptoms in long-COVID patients found a higher prevalence of depression, anxiety, cognitive and sleep disturbances, and post-traumatic symptoms compared to the general population¹⁷. The presence of these symptoms has been remarkably higher among those suffering from long COVID¹⁷, emphasising the need for sustained mental health support.

However, interestingly, pre-COVID-19 research found that survivors of intensive care units were already at higher risk of developing long-term mental health conditions, including anxiety, depression, and PTSD^17-18. Furthermore, public health measures like quarantine and lockdowns may have exacerbated these issues, contributing to higher levels of post-COVID depression and anxiety^19-20. This suggests that psychiatric symptoms in long-COVID patients may stem not only from the virus itself but also from the broader societal impact of the pandemic. Importantly, those who experience early psychiatric symptoms post-COVID may be at greater risk of developing more severe conditions if left unaddressed and untreated or mismanaged.

Comorbidities: mental health and addiction in post-COVID patients

The interaction between mental health and addiction is a growing concern in the post-pandemic world, with many individuals facing both issues simultaneously. Known as dual diagnosis, this term refers to the co-occurrence of a mental health condition alongside a substance use disorder, or multiple mental health conditions occurring simultaneously. In post-COVID patients, these comorbid conditions could end up being particularly complex, as the psychological and neurobiological effects of COVID-19 exacerbates existing issues or even triggers new dependencies.

The relationship between mental health issues and substance abuse is bidirectional – one can often fuel the other. For instance, depression and anxiety – which have been prevalent in post-COVID mental health treatment^13-16 – may lead to substance abuse as a form of self-medication, while addiction itself can worsen or trigger psychiatric symptoms. Research suggests that the prevalence of co-occurring disorders can be as high as in 54% of all cases, with males more frequently affected²¹. Factors like genetic predisposition, neurobiological changes caused by addictive substances, and exposure to stress or trauma contribute to the development of these dual diagnoses^22-25.

The wider consequences of dual diagnosis post-COVID are profound. These can include poor medication adherence, physical health comorbidities, increased risk of death from suicide, aggressive behaviour, and even incarceration²⁶. In the context of the pandemic, many individuals have faced a potential heightened vulnerability to substance use disorders²⁷, with reports noting an increased prevalence of alcohol- and drug-related deaths²⁸.

At Harbor, we specialise in treating mental health and addiction comorbidities, offering a whole-person approach that combines psychiatric expertise with addiction treatment. Our multidisciplinary teams, comprising psychiatrists, addiction specialists, and therapists, are skilled in addressing the complexities of substance use disorders, ensuring patients receive comprehensive care tailored to their unique needs.

Early intervention and importance of ongoing care

Early intervention plays a crucial role in improving recovery outcomes for patients facing post-COVID mental health problems and cognitive decline after COVID-19 infection. The longer symptoms such as depression, anxiety, and cognitive deficits remain untreated, the higher the risk of long-term complications. Early management of psychiatric symptoms can help to prevent the development of more severe issues, leading to better recovery trajectories.

At Harbor, we recognise the importance of timely, tailored intervention. Our comprehensive care approach, combined with our one-patient-at-a-time methodology, ensures that each client receives the attention they need from a multidisciplinary team.

Our experts, including psychiatrists, psychologists, and addiction specialists, work collaboratively to create bespoke treatment plans that address both immediate concerns and long-term wellbeing. This commitment to early intervention and ongoing support is key to managing the complexities of post-COVID psychiatric condition treatment and recovery.

Through an integrated approach that addresses both the physical and mental health challenges faced by our clients, our expert team is utterly dedicated to managing complex cognitive and psychiatric symptoms, ensuring a full and sustainable recovery. With a focus on cognitive rehabilitation, we tailor each treatment plan to meet the unique needs of the individual, offering bespoke solutions that go beyond immediate care.

Confidentiality and discretion are paramount. We understand that for many high-profile clients, maintaining privacy during their treatment is critical. Our mental health treatment and addiction rehabilitation service provision is designed to offer the highest level of care in a luxurious, confidential environment.

Get in touch with a member of the team today if you’d like to find out more about referring your patients or clients to us for 24/7, wrapped around care.

References

1. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00299-6/fulltext?ref=ourbrew.ph
2. https://academic.oup.com/occmed/article-abstract/55/1/20/1392403?redirectedFrom=PDF
3. https://www.medrxiv.org/content/10.1101/2022.08.08.22278543v1
4. https://www.mind.org.uk/about-us/our-policy-work/coronavirus-research/
5. https://www.ox.ac.uk/news/2024-08-01-long-term-cognitive-and-psychiatric-effects-covid-19-revealed-new-study
6. https://www.science.org/doi/pdf/10.1126/science.abm2052?fbclid=IwAR2qCT2mkbko3160Mj1CLNZwTQ37_DQzktPbjvGvZD9OhXu5aDEzc_xWNLQ
7. https://www.medrxiv.org/content/10.1101/2022.06.07.22276020v1
8. https://www.sciencedirect.com/science/article/pii/S0889159121006516
9. https://www.science.org/doi/full/10.1126/science.abm2052
10. https://www.nature.com/articles/s41586-022-04569-5
11. https://www.nature.com/articles/s41579-022-00846-2
12. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00260-7/fulltext?ref=ourbrew.ph
13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9865328/
14. https://link.springer.com/article/10.1007/s12035-018-1016-x
15. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.822382/full
16. https://www.preprints.org/manuscript/202201.0134/v1
17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10320160/
18. https://link.springer.com/article/10.1186/s13054-018-2223-6
19. https://www.sciencedirect.com/science/article/pii/S0165178120331231
20. https://www.mdpi.com/1660-4601/19/12/7313
21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9955022/
22. https://nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders/why-there-comorbidity-between-substance-use-disorders-mental-illnesses
23. https://pubmed.ncbi.nlm.nih.gov/22703173/
24. https://pubmed.ncbi.nlm.nih.gov/22367454/
25. https://pubmed.ncbi.nlm.nih.gov/18991954/
26. https://pubmed.ncbi.nlm.nih.gov/16961418
27. https://nida.nih.gov/research-topics/covid-19-substance-use#health-outcomes
28. https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1201967/full