Covid 19, Depression and Anxiety: Psychobiological Scars?

I am fascinated by debates on the Brain-Mind Relationship Question. Of course, there are many mysteries to be unraveled about this relationship. However, it is also evident - and this is an aspect I seek to emphasize whenever possible - that (roughly and for the purposes of this article) the brain is the foundation, from which we all start, for the constitutive trajectory of our existences - which have unique characteristics - from which our personalities, also unique, in many of their aspects will be structured.

Emotional traumas - in which this tragic epidemic of Covid 19 fits - interfere, with greater or lesser impact, in the purely biological sphere, in the existential sphere and in the constitution and restructuring of our personalities. However, these aspects are always interconnected, and the influences between them are multi-lateral. Prepared, experienced, humanized and informed clinicians know this.

The terrible experiences of loss of family and friends by Covid 19, without being able to monitor their hospitalizations, without being able to perform a farewell ritual for these loved ones, in the midst of so much fear, insecurity and isolation, are traumatic experiences of extremely high magnitude, with immense impact about the existence and personality of so many of us. Therefore, let us not imagine that this experienced doctor and therapist is disregarding these aspects.

However, there are data that seem to indicate that this pandemic is causing "scars" - in the foundation - that is, psychobiological, which is to be expected. I highlighted this, in a class, which I taught - at the invitation of Editora Artmed - to over 23,000 health professionals under the title; "Anxiety and Covid 19: Biopsychosocial reflections", months after the start of the pandemic.

Today, July 24, 2021, in the National Library of Medicine, of the National Institute of Health of the United States of America, if we cross the words Depression and Covid 19 we obtain 4,674 studies or literature reviews, which bring associations of anxiety symptoms, Anxiety Disorders, Insomnia and (as quoted) Depression and Covid 19.

I have been following these studies / literature reviews and I want to highlight a possible correlation, at first, I insist, psychobiological, in cases of patients who contracted Covid and who later started to present Depressive symptoms and/or Anxiety Disorders.

Just to cite one publication - from the Annals of the New York Academy of Sciences - which reviewed 31 studies, including 5,153 people, who were infected with Covid 19 and who survived, came up with figures showing a 45% prevalence of depression, 43% of anxiety disorders and 34% of sleep disorders, which may be possible post-covid sequelae. Publication data are: Meta-Analysis Ann N Y Acad Sci. 2021 Feb;1486(1):90-111. doi:10,1111/nyas.14506. Epub 2020 Oct 2. "The prevalence of depression, anxiety, and sleep disturbances in COVID-19 patients: a meta-analysis"

These numbers are scary. Classically, the prevalence of Major Depression, one of the causes of depressive symptoms, is between 5 and 12% in men and 10 to 25% in women, which are already considered very high numbers! It is the same with Anxiety Disorders. We consider the classic percentages of prevalence, already very high.

In Anxiety Disorders, classically, we have the following prevalences: Panic 2.0 to 4.0%, Phobias around 10%, Obsessive Compulsive Disorder around 3.0 to 4.0%, Generalized Anxiety around 01 at 03% in men and perhaps double in women and POST TRAUMATIC STRESS DISORDER with 1 to 03% in men and perhaps double in women, 30% in Vietnam War veterans and 36 to 39% in the Korean War. I am providing numbers that are repeated in the literature, but that may vary a little in different publications.

We cannot fail to notice that the numbers of the cited article, in patients who had Covid 19 are close to or higher than the numbers of POST TRAUMATIC STRESS DISORDER, in situations of war !!

It is important to point out that Anxiety, Anxiety Crises, Anxiety Disorders, the Stress Exhaustion Phase, Depressive Symptoms are not isolated events! In general, they are comorbidities in patients. They very often occur together.

Thus, we cannot rule out, given the number of publications and the percentages cited - which seem to be repeated in studies and literature reviews - that there is the possibility that a sick population is shaping up, regarding these conditions, perhaps, with psychobiological characteristics similar to those of a population of "war veterans" and perhaps even more affected. Evidently, in astronomically larger numbers, considering that the possibility that patients who had asymptomatic (no symptoms) or oligosymptomatic (with few and mild symptoms) Covid 19 may also have such sufferings.

This panorama makes sense, biologically speaking, because the causes of Post Traumatic Stress Disorder and the Stress Exhaustion Phase - which go together - were fully configured in the pandemic, such as: the evolution to a flattened Cortisol curve and its effect on the hippocampus, a brain region related to various aspects (memory, for example) but also involved in the Neuroscience of Anxiety, the possible effect of this increase in Cortisol at the prefrontal level, the most important brain region for cognitive life and also for " motivation" (volition, technically speaking), the release of certain substances called Cytokines, such as IL6, IL1 Beta, TNF Alpha, which generate and maintain a pro-inflammatory central ("brain") imbalance, which we call Neuroinflammation, which increases the activity of certain Amygdala ("brain") nuclei and connections that trigger anxiety and/or anxiety attacks and decreases the activity of the prefrontal region (cited above), which, in itself, at first, it might be enough to generate depressive symptoms.

This is the reasoning we use to explain - among other mechanisms - the depressive symptoms of those who go, in a process of chronic anxiety, from months to years, to the Stress Exhaustion Phase. In addition, these Cytokines seem to reduce the sensitivity of pleasure-related brain regions, such as the Accumbens Nucleus, which puts people in a greater situation to assume risky behaviors, such as the use of alcohol and other drugs, increased calorie intake, etc. Months after the start of the pandemic, I gave an interview to Rede Globo television - program SP1 - Brazil - S?o Paulo - in which I spoke briefly about the 136% increase - at that time - in alcohol consumption in the city of S?o Paulo!

These Cytokines also trigger, at the peripheral/immune level, a chronic pro-inflammatory situation, which can gradually degrade the function of noble organs (heart, kidneys, lungs) and lead to a decrease in the activity of several cells of the immune system, in addition to reduce the production of antibodies, with a decrease in the efficiency of the immune system. The Stress Exhaustion Phase, in which most of the population is, causes dysautonomia, in varying degrees - at Autonomous Nervous System - which can contribute to the emergence of various pathologies. These are technical details of Anxiety Neuroscience and Psychoneuroimmunology, disciplines I taught for years at the Federal University of S?o Paulo - Brazil - UNIFESP - Psychobiology Department.

The mental health structure to treat this possible panorama of a multitude of people with Depressive Symptoms, Anxiety / Anxiety Crises, people in Stress Exhaustion Phase, perhaps does not exist in practically any country! This Attention to Mental Health must be amplified and governments should already be rolling up their sleeves in this regard, but most have not even managed to control the epidemic. In addition, it is important to consider that the populations likely to be the most affected will be the professionals who are working on the front lines, at all stages, of this process, emotionally, immensely painful, that is: in hospitals, in security public (police, for example), in funeral procedures, etc. All people involved in this process will have a greater chance of developing these affections.

Therefore, I leave this brief analysis as a warning, with the hope of sensitizing people and in particular those who have the power to initiate collective projects in Mental Health Care, whether in the public and/or private sphere.

Gerald Possendoro - Psychiatrist and Psychotherapist - Anxiety Specialist

[email protected]

www.drgeraldopossendoro.com

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