COVID-19 and Depression

Written by Marijke Vroomen Durning, RN, Alexandra Benisek
Medically Reviewed by Melinda Ratini, MS, DO on November 05, 2024
10 min read

COVID depression is a mental health disorder similar to other types of depression but results from the virus that causes COVID-19. There seem to be chemical and biological changes in the body that might trigger COVID depression.

A few studies show that some people who have had COVID have lower levels of metabolizing (breaking down) glucose in their brain, for example. Others with depression after COVID have low levels of serotonin — the chemical that helps boost your mood. More studies are looking at how inflammation in your body and your brain, caused by the virus, may trigger depression.

Although your early COVID symptoms have gone away, you still might not feel completely normal. You may deal with constant headaches, fatigue, nervousness, or an overall feeling of dread that makes it difficult to complete daily tasks. While experts still need to study the long-term effects of COVID on the brain, over half of a U.S. COVID survivor sample reported symptoms of depression months after recovery. People with more severe COVID symptoms are more likely to have depression.

Researchers have also found that many survivors of COVID reported cases of posttraumatic stress disorder (PTSD), anxiety, insomnia, and obsessive-compulsive (OC) symptoms. Other studies showed that the prescription of antidepressants, intimate partner violence, and suicidal thoughts had gone up since the start of the pandemic.

Those who have had COVID appear to have a higher risk of developing a mental health disorder after recovering from the virus.

Experts believe that a COVID infection can affect your mental health in two major ways:

  • Your body’s immune response to the virus itself
  • The psychological stress of a COVID infection

When you get infected with the virus that causes COVID, your immune system produces cytokines, chemokines, and other things that promote inflammation. Experts found a specific kind of cytokine, called T-helper-2 cell-secreted cytokines, in people with COVID. Higher levels of these cytokines appeared to be linked to a more severe case of the virus. Experts found that if your body doesn’t properly control these cytokines, certain bad things can happen, such as:

  • Nerve inflammation
  • Blood-brain-barrier disruption
  • Peripheral immune cell invasion into the central nervous system
  • Impaired nerve transmission
  • Hypothalamic-pituitary-adrenal (HPA) axis dysfunction
  • Microglia activation and indoleamine 2,3-dioxygenase (IDO) induction

All of these represent the roots of psychiatric disorders, such as depression. This suggests that the actual effects of the COVID virus can lead to depression, even after a person recovers from the virus.

In a study, experts linked higher systemic immune-inflammation index (SII) levels — which refer to your immune response and inflammation — to major depressive disorder. Inflammatory factors such as SII were higher among men and people who stayed in a hospital during their COVID illness.

Other psychological factors can cause COVID survivors to get depression. People who had COVID and didn’t have to stay in a hospital showed higher levels of anxiety and sleep disturbances after recovery. Experts found that those who stayed in a hospital had higher levels of PTSD, depression, anxiety, and OC symptoms.

Studies show that these conditions resulted from emotional and mental stress, including:

  • Social isolation
  • Psychological impact of a severe and potentially fatal illness
  • Concerns about infecting other people
  • Stigma related to a COVID infection

In these studies, researchers found those assigned female at birth and people with previous psychiatric diagnoses had more severe mental health conditions after the start of COVID. Those who stayed in hospitals while infected with COVID also had higher social isolation and loneliness, since they couldn’t interact with as many people. In addition, younger people with COVID showed higher levels of sleep disturbances and depression. This further confirms past studies that reported younger people dealt with worse psychological impacts from COVID.

But experts still need to do more research to understand the link between COVID survivors and the signs of inflammation, mood disorders, and mental illness symptoms.

If you have COVID depression, you may have some or many of these symptoms. If you do, contact your doctor or seek help from a mental health specialist. 

For depression to be considered related to a past COVID infection, you must have the symptoms for four or more weeks after you initially had the virus. They can be constant or come and go. They can even worsen for months after your illness.

These are some symptoms related to depression in general:

  • Feeling sad
  • Feeling like you can’t enjoy anything
  • Feeling hopeless
  • Lacking energy, or being fatigued all the time
  • Being unable to concentrate on simple things, such as watching TV
  • Loss of appetite
  • Eating too much or “comfort eating”
  • Sleeping too much
  • Insomnia
  • Feelings of self-harm or suicide

If you have any thoughts of self-harm or suicide, please call 911 or reach out right away to the 988 Suicide & Crisis Lifeline. Dial or text 988.

Diagnosing COVID depression is done the same way as diagnosing any other type of depression, such as postpartum depression. There is no one test for COVID depression.

Your doctor or health care professional will ask you questions about how you’ve been feeling and anything that may have triggered those feelings. This is where you need to tell them that you have had COVID and your experiences about the illness. The questions your doctor may ask include:

  • How sick were you?
  • Did you have help?
  • Did you go to the hospital?
  • How long were you in the hospital?
  • Were you in an intensive care unit (ICU)?
  • What was your recovery like?
  • Do you take any medications?
  • Did the symptoms begin before or after you had COVID?

There are also the standard depression diagnostic tests that your doctor or mental health professional will use to make a diagnosis. These tests include:

  • Physical exam, to check for any physical reasons causing the depression symptoms
  • Blood tests, to check for any medical reasons, such as an underactive thyroid (hypothyroidism), which often causes fatigue, feelings of sadness, loss of enthusiasm, and so on.
  • Mental health evaluation, to assess your feelings, thoughts, and physical symptoms. There are several diagnostic screening tests and questionnaires that could be used.

Mental health professionals aren’t yet sure of the best treatments for COVID depression treatment because they still don’t know the actual cause. 

The first goal is to manage the symptoms. This could mean taking an antidepressant, for example. Aside from that, experts recommend:

Peer support. Meeting with others who have long COVID and associated problems, such as COVID depression, can help people understand their own experiences and get a sense of belonging and acceptance. Support groups can be in-person or online.

Individual psychotherapy. A mental health professional can use techniques such as cognitive behavioral therapy to help you learn about your symptoms, what might trigger them, and how to manage them so they aren’t as disruptive.

Group psychotherapy. Working with others in a group setting under the guidance of a mental health professional, group members can share their experiences and work on different techniques, as you would in an individual session.

If you need to recover from the physical effects of COVID, consider joining a rehabilitation program. It can help you regain physical strength, which, in turn, can help your mental state.

Living with COVID depression can be challenging, but you can take some steps to feel better and move forward. Here are some examples:

  • Take care of yourself.
  • Acknowledge that you are going through a tough time and allow yourself to know that this recovery will take time.
  • Be kind to yourself.
  • Eat healthy foods.
  • Limit alcohol consumption.
  • Avoid smoking and vaping.
  • Be active, whether it’s just taking a daily walk or doing something more formal, such as joining an exercise class.
  • Try to get enough sleep.
  • Ask for help if you need it.
  • Connect with others, either as an informal thing or getting together with others who are living with long COVID or COVID depression
  • Try to do things that are meaningful to you — small achievable acts that will make you feel good.
  • Keep a journal or diary about your recovery, and write about your accomplishments and any positive progress.

Some people with undertreated, untreated, or unrecognized COVID depression can become severely ill, and this can lead to a medical emergency. Seek emergency help immediately by calling 911 or 988 — the Suicide & Crisis Lifeline — if you or someone you know experiences any of these signs:

  • Repeated thoughts of self-harm
  • Repeated thoughts of death or suicide
  • Wanting to die
  • Attempting suicide

If you have COVID depression, especially if it’s not treated, you could experience some complications. These include:

  • Obesity. Excessive weight can cause chronic health issues such as diabetes or high blood pressure
  • Physical illnesses. Pain and some physical illnesses can get worse if you have depression. This includes heart disease, strokes, and Alzheimer’s disease.
  • Misusing drugs or alcohol. The pain of depression can cause some people to self-medicate, and they may use drugs or alcohol to feel better.
  • Self-harm or death. Thoughts of self-harm or suicide are medical emergencies that can occur when someone has depression.

Whether you’ve had a case of COVID or not, the pandemic has affected all of us in some way. Many pandemic-related things can affect your mental health:

  • Trauma from a widespread disease
  • Fear of getting sick
  • Grief from losing a loved one, or from the loss of life in general
  • Physical distancing and the lack of socializing
  • Financial concerns (unemployment, housing security)
  • Loss of community
  • Less access to caregivers

After most traumatic events, depression tends to peak right after and then fall over time. But studies show that the rate of depression after the start of the COVID pandemic actually went up. Those who were hit hardest with long-term mental health impacts include:

  • Families or people with a low household income
  • Unmarried people
  • Those who faced multiple pandemic-related stressors

In the U.S., 32.8% of adults had higher levels of depressive symptoms in 2021, compared to 27.8% of adults in the early months of 2020 and 8.5% before the pandemic.

This suggests that experts must continue to research the link between the pandemic and mental health, including how the COVID virus directly affects mood disorders.

If you think you may be depressed or have noticed symptoms of other mental health disorders, talk to your doctor right away to get the help you deserve.

COVID anxiety

People who have had COVID can experience COVID anxiety for several reasons. Some amount of worry can be normal, but if it starts to affect your life, speak with your doctor or a mental health professional so you can try to get a handle on it. 

Here are a few reasons why someone might develop COVID anxiety:

Fear of getting the infection again. If you have had COVID, especially if you were very ill, it can make you anxious. It can even cause posttraumatic stress disorder, or PTSD. Hospital stays, especially in ICUs, can be strong anxiety triggers. Just thinking about getting it again can scare you. 

Fears of loved ones getting COVID. You know what it’s like and the effect it had on you. You may be anxious about loved ones getting sick, especially if their health isn’t the best to begin with.

Fears of your recovery. Usually, when we get sick, we get over it and then go back to living our lives. However, this might not be the case if you have long COVID. This may make you anxious about whether you'll ever fully recover.

Financial worries. People who can’t work or who have cut back their work hours because they were sick with COVID may get very anxious about their finances.

Doctors still have a lot to learn about long-COVID complications, including COVID depression. They do know that like other types of depression, COVID depression is complicated. You could have a higher risk of developing COVID depression if you had to be admitted to a hospital, especially in an ICU. If you think you may have COVID depression, speak with your doctor or a mental health professional. You’re not alone and seeking help is important.

What are the most common causes of stress during the COVID pandemic?

The most common cause of stress during the COVID pandemic was isolation. Suddenly, people were forced to stay home and weren’t able to participate in their usual activities. Other common causes of stress were financial worries, fear of infection, and fear for loved ones.

Can a virus cause depression and anxiety?

Yes, a virus can cause depression and anxiety. With COVID, some experts believe that the virus directly affects the brain of some people infected with the illness. Studies point to the virus damaging two types of cells that are vital for the brain’s function and ability to repair itself.

Can infections make you depressed?

Some physical illnesses, including viral infections, can make you feel depressed.

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