It’s pretty obvious to say that the last year has taken a general toll on our mental health and will continue to do so in the years ahead. Many have dealt with depression and anxiety and others have not only battled with the virus but have continued to struggle in the aftermath. For these individuals and those who have had the virus but been asymptomatic, the mental health problems they are now presenting may be the sign of something more, namely post-viral syndrome. Unfortunately, many patients are presenting with concerns that would be diagnosed as depression or anxiety and given those treatments, but those treatments will not only not work but worsen things. Psychotherapist Noel McDermott believes it’s crucial to factor in the possibility of post-viral syndrome when looking at a patient presenting common mental health problems at this time.
Psychotherapist Noel McDermott comments: ‘Post-viral mental health concerns are the product of a viral infection. PVS needs a range of medical and rehabilitation supports as it won’t respond to psychological therapies or standard medication for anxiety and depression available from your GP. Treating PVS as primarily a psychological health issue will likely worsen the condition, with the possibility of it becoming more chronic. PVS is believed to be an inflammatory and immune system response. It will only become clear that it is PVS by taking a full personal history and looking for signs of possible viral infection, or by inferring the presence because someone doesn’t respond to psychological approaches.’
Post-viral issues can occur in people who were asymptomatic when infected with coronavirus. Post-viral issues are presenting, for example, in children and young people who showed no signs of viral infection. Sadly, children, in particular, may not be diagnosed correctly with post-viral issues as they will often have been asymptomatic when infected.
- The symptoms of PVS such as excessive fatigue or exhaustion are pretty defining, for example, the presence of fatigue after physical exercise is a big warning sign.
- Joint aches and muscular pain or stiffness
- Breathlessness such as shortness of breath, laboured, noisy breathing, and difficulty catching your breath
Warning signs of mental concerns such as depression and anxiety
Warning signs of depression or anxiety that are severe enough to interfere with day-to-day living and have been with you for more than two weeks, for example:
- significant loss or addition of weight
- big changes in appetite
- problems with sleep or energy levels
- lack of positive outlook on the future
- increase or excessive use of alcohol (or drugs)
- withdrawal or anger and rejection
- a sudden or significant drop off in work or education performance
If the symptoms of depression or anxiety alleviate after physical exercise, then it’s probable it is primarily psychological in nature.
If you’re unsure if you’re suffering from post-viral syndrome or a more general mental health concern, it’s important to note that if your feelings of anxiety and depression do not respond within two months to psychological approaches and standard medication, then this should be seriously reviewed.
Treatment for anxiety and depression involves, in the first place, cognitive behavioural therapy (CBT) and/or mindfulness-based cognitive behavioural therapy. For some people, medication is useful to help reduce their symptoms so they can do the lifestyle changes needed for long term recovery. Psychological treatments are relatively short term (up to three months) and focus on changing thinking styles to reduce anxious or depressive thoughts and focus on behaviour changes that encourage general well-being and greater social support.
Mental health interventions for depression, for example, stress what is called behavioural activation and exercise as ways of recovering. These approaches, when applied without a proper physical rehab plan, may actually cause harm, as physical rehab from Covid and post-viral works on the principle of not putting strain on your body but working well within physical limits.
Post viral syndrome isn’t primarily a psychological issue. Like chronic fatigue, it’s linked more to a physical illness or injury creating inflammatory responses and problematic immune responses. Psychological therapies won’t treat post-viral problems and, if this is the only intervention offered, it may lead to serious long-term chronic illness. Post-viral syndrome and chronic fatigue, and now long Covid, are complex issues needing a holistic assessment of need and planned and coordinated rehabilitation.
Noel comments: ‘Mental health and wellness are on a spectrum and, although many people will have struggled in the pandemic, most will see improvement as we socialise with friends and family again. For most of us, the love of those closest to us is the therapy we need. However, it’s vital at this time that psychological therapists question closely the presentation of common mental health issues, especially if there are signs of treatment resistance – recently NICE removed CBT from the treatment of chronic fatigue for just these reasons.’
Noel McDermott is a psychotherapist with over 25 years’ experience in health, social care, and education, with a range of online therapy resources to help clients.