How to manage a patient with COVID-19 and depression
Dr Kieran Walsh
There are growing concerns that the COVID-19 pandemic may be causing a mental health pandemic. There are a number of reasons underlying these concerns. Patients with COVID-19 may have an increased risk of mental health problems, such as depression. Fear of COVID-19 infection may cause anxiety in people who are predisposed to such disorders. Other physical conditions associated with COVID-19 may contribute to psychological problems (for example delirium is very common and may contribute to post traumatic stress disorder). And lastly there are the unwanted side effects of the measures taken to contain COVID-19. These can result in social isolation with resultant loneliness and depression.
Hossain and colleagues have recently published a review on the epidemiology of mental health problems in COVID-19. (1) In their paper, they point out the wide range of potential mental health problems that are directly or indirectly associated with the pandemic. They found that the pandemic has been associated with “a high epidemiological burden of depression, anxiety disorders, stress, panic attack, somatization disorder, sleep disorders, emotional disturbance, PTSD symptoms, suicidal behavior, and many more mental health problems.” Importantly the reviewers look at the issue of mental health problems among healthcare providers. They found high levels of fear, anxiety and depression amongst healthcare staff in the studies that they looked at - these included doctors, nurses, and allied healthcare professionals. The reviewers conclude by emphasising the importance of identifying people who might be at highest risk for developing psychiatric complications.
Patients with a past history of psychiatric problems who then develop COVID-19 infection may be most at risk. For example, a patient with depression who develops COVID-19 might especially struggle with the rigors of social isolation or the worry of hospitalisation. Dexamethasone for COVID-19 could worsen their mental health symptoms. New treatments for COVID-19 could interact with antidepressants. Low mood might adversely affect rehabilitation, motivation and recovery. It's a lot to remember - yet this is just one patient with one acute illness and one comorbidity. Many patients have many more.
These problems add to the challenges that healthcare professionals face when caring for patients with COVID-19. We have built the Comorbidities tool from BMJ Best Practice to help them overcome these challenges. If you are interested, have a look at the treatment algorithm on the COVID-19 topic on BMJ Best Practice. And add depression as a comorbidity.
1. Hossain MM, Tasnim S, Sultana A, Faizah F, Mazumder H, Zou L, McKyer ELJ, Ahmed HU, Ma P. Epidemiology of mental health problems in COVID-19: a review. F1000Res. 2020 Jun 23;9:636. doi: 10.12688/f1000research.24457.1. PMID: 33093946; PMCID: PMC7549174.
KW works for BMJ which produces the Comorbidities tool from BMJ Best Practice.