Depression, depressive symptoms common in long COVID

Depressive symptoms and clinically significant depression were frequent more than 12 weeks after SARS-CoV-2 infection, according to a systematic review published in Journal of Psychiatric Research.

“Recent reviews have investigated the neuropsychiatric sequelae of COVID-19, but to our knowledge, none have reported on the frequency of depression, specifically, in accordance with [National Institute for Health and Care Excellence]-defined post-COVID-19 syndrome,” Olivier Renaud-Charest, of University of Toronto’s University Health Network and McGill University’s faculty of medicine and health sciences, and colleagues wrote. “Notwithstanding, studies reporting on the survivors of the severe acute respiratory syndrome (SARS) pandemic in 2003 have indicated the presence of depression for up to 12 months following hospital discharge. Thus, it may be hypothesized that depression is a significant outcome among survivors of coronavirus infections.”

Renaud-Charest and associates reviewed six uncontrolled observational studies and two prospective cohort studies published between Jan. 1, 2020, and June 5, 2021, that examined reverse transcriptase polymerase chain reaction (RT-PCR)-confirmed COVID-19 in conjunction with depressive symptoms and clinical depression.

Among the eight studies, five scored high on the Newcastle-Ottawa Scale (NOS) quality evaluation and three had moderate NOS scores.

Frequency of depressive symptoms more than 12 weeks following infection ranged from 11% to 28%, and clinically significant depression rates ranged from 3% to 12%.

While most studies evaluated depression at 3 or 4 months after diagnosis or discharge, one evaluated depressive symptoms and depression severity at 6.5 months after hospital discharge, which found a rate of 27% for moderate symptoms and 5% for severe symptoms.

Depression was associated with female sex, previous psychiatric diagnosis, psychopathology at 1 month and systemic inflammation during the acute phase; age was only a potential factor and severity of acute COVID-19 was not, Renaud-Charest and colleagues wrote. Depression remained prevalent at 1- and 3-month follow-ups, though PTSD symptoms, anxiety and insomnia decreased between those times.

Depressive symptom severity was proportional to baseline systemic inflammation, which “explained the variation of depression severity in models when assessing the influence of age, sex and hospitalization,” they wrote.

Neurocognitive function did not moderate depression in acute COVID-19, but depressive symptoms did significantly influence neurocognitive function in post-COVID-19 syndrome.

Limitations included heterogenous study designs, absence of controls and no assessment of baseline depression or prior acute infection.

Roger McIntyre

“We now know that depressive symptoms represent a significant component of post-COVID consequence,” study author Roger McIntyre, MD, FRCPC, of University of Toronto’s University Health Network, Institute of Medical Science and departments of pharmacology and toxicology and psychiatry, told Healio Psychiatry. “We should be vigilant to the possibility of suicidality associated with post-COVID consequence, and future research should attempt to understand more fully the underlying neurobiology. Perhaps the neurobiology of post-COVID consequence overlaps with major depression.”