Covid, a study of surviving patients confirms: 'Persistent depression in the aftermath of illness'
Covid patients and depression: results of a new study coordinated by Francesco Benedetti, a psychiatrist at IRCCS Ospedale San Raffaele
Three months after discharge, about one-third of patients admitted for Covid-19 continue to suffer from psychopathological disorders such as depression, anxiety, insomnia, and post-traumatic stress syndrome
Depression, in particular, persists the longest, and its severity is closely linked to the intensity of the systemic inflammatory state that follows severe forms of Covid-19, even for months after recovery.
The good news is that patients with these forms of depression are particularly responsive to available psychological and pharmacological therapies.
These are the results of a new study coordinated by Francesco Benedetti, a psychiatrist, Group leader of the Research Unit in Psychiatry and Clinical Psychobiology at the IRCCS San Raffaele Hospital, and associate professor at the University Vita-Salute San Raffaele, and published in the scientific journal Brain, Behavior and Immunity.
This is a continuation of research published by Benedetti’s group in August 2020, which had first described the psychiatric consequences of Covid-19 one month after discharge.
The study was conducted on 226 patients taken into care by the post-COVID-19 follow-up outpatient clinic set up by San Raffaele Hospital in May 2020.
The outpatient clinic provides a pathway of periodic follow-ups with multidisciplinary teams of internists, neurologists, psychiatrists, nephrologists, and cardiologists, continuing up to 6 months after discharge.
COVID PATIENTS: POSTCOVID-19 INFLAMMATION AND PERSISTENT DEPRESSION
Compared to the other disorders found in the patients (anxiety, PTSD, insomnia) – which showed substantial improvement during the three-month follow-up, irrespective of the subjects’ gender and previous psychiatric history – depressive symptoms were found to be much more persistent over time and in direct correlation with systemic inflammation index (SII) values, which can remain elevated for months after recovery from acute infection.
Depression and inflammation also correlate with the reduced neuro-cognitive performance of the subjects, which is a typical consequence of depressive states: we are talking about reduced attentional capacity, memory, psychomotor coordination, and language fluency that persists during the long convalescence from the disease and affects a general slowdown in cognitive processing speed.
“We know that people suffering from major depression have higher levels of inflammatory cytokines in the blood, regardless of whether they have had infections or diseases of the immune system, and we know that this inflammatory state is associated with a reduction in the activity of certain neurotransmitters essential for the control of emotions, such as serotonin.
We also know that strong inflammatory states – even as a result of viral and bacterial infections – increase the risk of depressive episodes,” explains Professor Benedetti.
“Covid-19 is a paradigm of this phenomenon and further confirmation of decades of research in this field: if inflammation does not subside, a depressive episode may develop in the months following the acute illness.”
The study also gives a positive message to people who have dealt with a severe form of Covid-19 and now suffer from depression.
“Thanks also to the fact that we are beginning to understand the mechanisms underlying these disorders, the available therapies – psychological and pharmacological – can be chosen in an accurate and personalized manner, and are therefore particularly effective,’ Benedetti concludes.