Depression, Anxiety in COVID-19 Indicators of CNS Attack?

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Depression and anxiety in patients with COVID-19 may reflect penetration of the novel coronavirus into the central nervous system (CNS), researchers say.

In a cross-sectional study of more than 100 adult participants who had COVID-19, depressed mood and anxiety were closely correlated with loss of smell and taste and not with shortness of breath, cough, or fever.

Changes in mood and anxiety in patients with COVID-19 "may be more than emotional reactions to the disease," corresponding investigator Ahmad R. Sedaghat, MD, PhD, University of Cincinnati College of Medicine, Ohio, told Medscape Medical News.

The "unexpected finding" that depressed mood and anxiety were most strongly tied to olfactory dysfunction "raises the very intriguing possibility that mood changes and anxiety may be a function of invasion of the virus into the central nervous system and brain," Sedaghat added.

The results were published online July 2 in The Laryngoscope.

Higher Scores

The study included 114 patients (mean age, 44.6 years; 45.6% male) diagnosed with COVID-19 at Aarau Cantonal Hospital in Switzerland. Only one participant had previously been diagnosed with anxiety, and one other had previously been diagnosed with anxiety and depression and was being treated for it.

The investigators used the two-item Patient Health Questionnaire (PHQ-2) to measure depressed mood and the two-item Generalized Anxiety Disorder questionnaire (GAD-2) to measure anxiety levels at enrollment and immediately before the COVID-19 diagnosis.

Participants also rated symptoms of decreased smell/taste, nasal obstruction, excessive mucus production, fever, cough, and shortness of breath during COVID-19.

Symptoms of COVID-19 had started a mean of 12.3 days prior to enrollment. At enrollment, participants' PHQ-2 and GAD-2 scores were significantly greater than their pre-COVID-19 baseline scores (P < .001 for both comparisons).

At enrollment, when participants were still experiencing COVID-19 symptoms, 47.4% reported at least several days of depressed mood each week (PHQ-2 score of at least 1), while 21.1% reported depressed mood nearly every day (PHQ-2 score of at least 3).

Similarly at enrollment, 44.7% of participants had a GAD-2 score of at least 1, and 10.5% of participants had a GAD-2 score of at least 3.

Psychological Toll

In multivariable analysis, depressed mood and anxiety were positively associated with COVID-19 symptoms of decreased sense of smell/taste, but "surprisingly" not with the other COVID-19 symptoms of fever, cough, or shortness of breath.

This "may be harbingers of more dire COVID-19 outcomes," the researchers write.

"None of these symptoms that portended morbidity or mortality was associated with how depressed or anxious these patients were. The only element of COVID-19 that was associated with depressed mood and anxiety was the severity of patients' loss of smell and taste," Sedaghat reported in a news release.

Older age and pre-COVID-19 levels of depressed mood and anxiety were also positively associated with greater depressed mood and anxiety during COVID-19 illness.

"There may be more central nervous system penetration of the virus than we think based on the prevalence of olfaction-associated depressed mood and anxiety. This really opens up doors for future investigations to look at how the virus may interact with the central nervous system," Sedaghat said in the release.

He noted that it is unclear to what extent this psychological distress may be long term.

However, "understanding the heavy psychological toll taken on these patients is the first step to realizing that mood and anxiety disorders may be some things that need to be followed for the long term," Sedaghat told Medscape Medical News.

Monitoring Patients Key

Commenting on the study for Medscape Medical News, Nicholas R. Rowan, MD, Johns Hopkins University School of Medicine, Baltimore, noted that symptoms of smell loss are very common for patients with COVID-19, which is incredibly distressing for them.

"The quality of life implications of smell loss are very real, and may pose significant mental health implications for patients, such as depression or anxiety," said Rowan, who was not involved with the research.

"We do not yet know how many patients with COVID-19-related smell loss will have a permanent loss. Many will recover. However, it appears that there may be a proportion of the population infected with a lasting problem," he noted.

"It will be important to monitor patients with symptoms of smell and taste loss," he added.

Funding for the study was provided by Aarau Cantonal Hospital Department of Otolaryngology. Sedaghat and Rowan have disclosed no relevant financial relationships.

Laryngoscope. Published online July 2, 2020. Abstract

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