Hacker News Reader

Comment by Zanneth | Hacker News Reader

A lot of the symptoms of “Long COVID” are exactly the same as depression and anxiety symptoms. Brain fog, fatigue, muscle weakness: anyone who has ever had depression knows what this is like. Of course there are a small number of people who had severe illness from COVID and had to be hospitalized, and the road to recovery for them is quite long, but most people claiming that they suffer from Long COVID are not the ones who were hospitalized.

The fact that there is no diagnostic test that tells you whether you have Long COVID or not leads me to believe that this is yet another hidden manifestation of mental illness. I feel sympathy for people going through this, but it’s wrong to expect the medical industry to come up with any solutions.

View on HN

Long Covid has a collection of effects on the body which can be observed using commonly-ordered tests. A dramatically reduced serum cortisol is one.

Hyperactivity of the amygdala, commonly associated with depression, also causes changes in cortisol levels. [1]

[1] https://neuro.psychiatryonline.org/doi/10.1176/appi.neuropsy...

Not a lot of people know this, but depression also has a collection of effects on the body.

https://lorienpsych.com/2021/06/05/depression/

Depression and anxiety can have very significant effects too, way beyond what people would assume. I spent years thinking I had a serious health disorder, but in the end? Just anxiety causing all the symptoms.

That's not all. We also have "T cell alterations, including exhausted T cells, reduced CD4+ and CD8+ effector memory cell numbers and elevated PD1 expression on central memory cells" which might help narrow it down for the non-believers. I didn't want to post a laundry list, but can post more if necessary.

There are likely multiple completely different underlying root causes which are being conflated together. Some cases may be psychosomatic. But post-viral syndrome has been recognized since at least 1987. It appears that many different viral infections can cause persistent damage to cellular metabolism in a subset of patients, and SARS-CoV-2 is nothing special in that regard. We need more basic research to understand what's really going on.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1710789/

Brain fog, fatigue, muscle weakness: anyone who has ever had depression knows what this is like.

I've had depression and I've had depressed friends. None of us ever had those symptoms.

Were you clinically diagnosed? It is quite common for people suffering from depression to not even be able to get out of bed in the morning.

I too have had depression and I have also had depressed friends. All of us have had those symptoms.

Including actual weakness of muscles?

Yes.

How do you reliably measure actual weakness of muscles? There is a huge neurological and psychological component to strength. My level of motivation and willingness to suffer has a huge impact on the amount of force that I can exert in a strength test. If I think I'm sick then that reduces my confidence and my ability to perform to my maximum potential even if there's nothing physically wrong.

That said, I do think there is probably some mitochondrial dysfunction going on in a subset of Long Covid patients that reduces muscle strength. But we don't have a good way to measure it and don't even know what to look for.

Absolutely.

I'm not sure how that's unreasonable. Depressed people tend to lounge or lay around in bed all day, tired, sad, feeling helpless. I can days or weeks causing muscle atrophy (maybe not a ton) but enough that when actually move you feel sore. Perhaps they've stopped going to the gym. Some people tend to under eat while depressed which can lead to no energy and your muscles not getting adequate nutrients which could cause cramps and pain.

So it's seems absolutely possible to experience "actual weakness of muscles"

What you describe sounds like: depressed --> move less --> weaker muscles. It also sounds gradual.

Long Covid is different. covid --> weak muscles. Also, it is more acute.

That's why depression is classified as a disorder and not a disease. We really don't know the full range of causes and it seems likely there's several different ones.

I have had depression for years. And some of the people I know who also have depression have these symptoms. Turns out not everybody reacts the same way to everything!

It seems highly unlikely that millions of people get a depression right after an infection with covid.

It seems more likely that the significant lockdowns and deep isolation that came with it had these same effects. When you can't see friends for months, can't do anything but stay home and watch tv/play video games, and are constantly exposed to news of a depressing, ill world - what else do you feel?

You don't need covid to feel "Long Covid" after the life we've lived in the last 2 years.

That's testable. It should be possible to compare the rate of "long covid" issues between people who tested positive for covid at some point, and people who didn't. Break it down by area so you're comparing populations with the same isolation rules.

This would be an especially good comparison since it's unlikely that people who caught covid were more isolated on average.

A lot of people were severely negatively affected by the world's reaction to the pandemic. Businesses closed, jobs lost, financial insecurity, etc. Surely this could have an impact on the collective mental health.

The problem is that it also seems highly unlikely that a respiratory disease that primarily attacks lungs, results in long-term depression.

Whataever physiological connection exists there, is far from obvious. And I haven’t found concrete studies to explain it.

Covid is not just a respiratory disease. It can affect "the heart, kidneys, skin and brain. Inflammation and problems with the immune system can also happen," according to Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/coronavirus/i...

They're mainly talking about severe cases, but it doesn't seem that unlikely that it could also have more mild effects to those organs.

This article is about Long Covid, so in a sense this is circular evidence.

Nonetheless, the two qualifiers in the statement "People who had severe illness with COVID-19 might experience organ damage affecting the heart, kidneys, skin and brain" weakens the argument. If the long-covid issue was just that people who were in ICU then had long-term symptoms, that's an easy premise to understand. But IMHO, for mild symptoms, there's a non-obvious leap to say that long-term brain damage somehow occurred.

"A large study comparing brain scans from the same individuals before and after SARS-CoV-2 infection suggests that brain changes could be a lingering outcome of even mild COVID-19."

https://jamanetwork.com/journals/jama/fullarticle/2790595

Very early on, I came to the conclusion that COVID is a blood disease, and subsequent findings (especially about effects on the epithelium) have generally backed that up. That means it's capable of affecting practically any organ, including the brain and various hormone-producing glands, so the myriad symptoms associated with Long COVID aren't that surprising.

More recently, I've seen some scientific back-and-forth about whether Long COVID is novel or just a form of already-known post-viral syndrome. I sort of feel like it doesn't matter. Even if it is "just" post-viral syndrome, it seems to be particularly severe and widespread. Whichever theory turns out to be correct (including the "just depression" theory), the empirical fact of Long COVID's existence has more to do with my continued caution than any fear of acute COVID. Getting older has been and will continue to be "fun" enough without that.

It doesn't primarily attack lungs. It's novel, so it hasn't evolved a particular favourite target. It attacks everything. If you really want to hang a sign on it, a large number of symptoms are repercussions of vascular damage (in the lungs, brain, kidneys, etc). Many are arguing that Covid is far more a vascular problem than a lung ailment.

And even if they did, that doesn't mean covid didn't physically cause it. HIV for example can cause depression by physically damaging the brain.

https://www.health.com/condition/depression/conditions-linke...

I guess if I had to watch family members and friends die via a video chat, or not being able to visit or hold their handle in their last moments? Or you know attend a funeral.

Nope can't see that leading to depression. Everything is fine.

I generally think that mental illness is on par with physical illness, to the degree that you can differentiate them. If it’s worth our time to worry about one, it’s worth our time to worry about the other.

We need to correctly diagnose the issue to "worry" constructively about it. Many in the Long COVID community start from the assumption that their symptoms are caused by a totally novel post-viral syndrome, and are very against exploring the idea that this could be a mental health issue.

I can't tell if you're claiming that people claim that 1.) post-viral covid is totally novel, of if 2.) Post-viral syndrome is totally novel.

However, it reads to me like you're saying that there is no way post-viral syndrome could be a real cause. If they see a competent doctor, I'm pretty dure that they'll investigate depression as a cause, and make an attempt to verify or rule it out.

Post-viral syndrome has been recognized since at least the mid-80's, roughly [1]. As far as it goes, if someone gets covid and has horrible symptoms of depression afterwards, then it's certainly plausible that it's caused by post-viral syndrome.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1710789/

I think that's a very wrong way of thinking about it. Mental illness is illness and ultimately will always have a physical cause. My more optimistic take is that this will lead to us better understanding how things like pathogens and environmental factors can cause syndromes that manifest as mental illness. Which is to say this could be both depression and long covid and the two could be intertwined. And it may lead us to looking at how influenza or air pollution or cell phone radiation or whatever else is causing depression symptoms.

I say this as someone who was in the same boat for a while. I was suffering persistent fatigue, malaise, anxiety, sleep disruptions. The kind of thing frequently diagnosed as depression. Only I eventually graduated to a specific enough symptom to get a diagnosis of specific physiological cause. A disease that was only positively attributed to specific neurological malfunction 20 years ago and one that is very difficult to test for directly. In reality, I _was_ depressed by the "quacks like a duck" theory of disease. That doesn't mean I didn't have a treatable illness no different than heartburn or cancer. It's only a matter of time (maybe a lot of time) before we really can "cure" most forms of depression.

This is just so, so wrong in many ways. Read about post-viral diseases such as Me/CFS that closely mirrors what Long Covid sufferers are going through. Watch "Unrest" on Netflix. Stop telling people who have serious physical symptoms that it's all mental. Just stop.

Are there any physiological or biological signatures for Long Covid? Is there any objective way to diagnose?

The symptoms of Long Covid are so vague and our recent work so wacky, you could use the same criteria used to diagnose Long Covid to diagnose "Long Lockdowns Syndrome" with all the same vague symptoms.

There is lots and lots of research into the similarities of Long Covid and other post-viral illnesses despite the fact that people only recently started reporting these symptoms:

"This study supports prior findings that ME/CFS occurs with high prevalence among those who have persistent COVID-19 symptoms." - https://www.mdpi.com/2035-8377/15/1/1

Long Covid symptoms are not vague. If you argue this, you have not done enough research into what people are battling. A majority of Long Covid haulers suffer from PEM (Post Exertional Malaise) which is a primary symptom of ME/CFS, and even thought research on this subject has been performed for decades, We currently don't understand what causes it. There are many theories for ME/CFS which could fit well with Long Covid, including an activation of the Epstein-Barr virus which causes neuroinflammation, and if this neuroinflammation primarily centers on the brain, it explains all the symptoms that people are reporting.

There are: https://www.nature.com/articles/s41579-022-00846-2

Fibromyalgia is a similar issue and I'm sure there are hundreds of others, our understanding of the human body still has a long way to go.

> The symptoms of Long Covid are so vague

They’re often worse than that. A lady was interviewed on Radio 1 a few days ago and she had recorded over 100 (!) symptoms in herself that she attributed to long COVID.

The fun part of the story was she was never diagnosed with COVID at any point since 2020. She assumed when she got sick in March of 2020 it was COVID and that’s when her problems began.

Everything about her story pointed strongly to serious mental health issues, but she completely rejected even the idea that was possible.

I'm willing to be proven wrong. Up until now, there hasn't been a lot of scientific evidence pointing to a specific physiological cause.

I bet cases of fibromyalgia and chronic fatigue syndrome are down while long covid is up.

"Stop telling people who have serious physical symptoms that it's all mental"

As someone who has serious physical symptoms stemming from mental disorder, I think you're being a dick. The experience is the same even if the root cause is mental. And your attitude belittles it.

Nowhere did I say mental disorders are better or less harmful than physical disorders, and nowhere did I say that the experience is not the same from a patient's point of view. However, there's a great difference in how the medical profession treats people with physical and mental disorders, and these patients are being told repeatedly by the entire world that they are feeling what they are feeling because of anxiety, depression, etc, which is flat out wrong. As a person who has also battled with mental problems, I'll be the first to point out that that's a big, big problem.

Ok I misinterpreted you then. It ticked me off when you seemed ask people to not mistake "real" physical stuff from mere mental stuff. Sorry.

No worries, I get it. That's another big problem!

That, or, it gives credence to theories that depression can have a physiological component or origin in at least some cases.

It also blurs the line between physical and mental illness. Where do neurological disorders end and mental illnesses begin?

Calling it 'exactly the same' is doing a lot of heavy lifting. I've struggled on and off with depression and the symptoms people report for long covid are not at all like those I or others with depression I've talked to. General fatigue/exhaustion for example doesn't mean I quickly run out of breath when doing normal activities or struggle to do tasks I normally took for granted.

Perhaps you and I have had different experiences with depression. For me, basic physical activity is completely exhausting when I am going through a depressive episode.

Then your statement is incorrect. You said 'anyone who has ever had depression knows what this is like'. I am anyone and I disagree.

> The fact that there is no diagnostic test that tells you whether you have Long COVID or not leads me to believe that...

...we don't know everything about the human body and immune system and medicine and still have a lot to learn.

I swear there's a dismissive comment like this on every single long covid article on HN

"BREAKING NEWS: Being locked down for almost 2 years with limited travel and physical interaction causes depression find out about Pfizer's new cure at 11"

I don't see how anyone can deny the risks inherent to getting a shot. However insignificantly low you can demonstrate the possibility of side-effects from the vaccine are, the risks associated with actually getting covid were just as low.

Given the vaccine isn't even preventing covid now, you're only compounding your risk by getting it. This is undeniable no matter what you think about vaccines, mandates, etc.

Can't believe we're still having this debate. There are indeed risks to the vaccine. There are also risks to covid (both immediate and longer term). My understanding based on the research is that for the vast majority of the population the sum of the risks of vaccine plus (usually) a milder case of covid are materially lower than the risks of getting covid if you're unvaccinated.

A vaccine doesn't have to stop you getting something to reduce your risk of serious illness, death and possibly long covid.

I think the risks of lying in a hospital, strapped to a ventilator were a lot higher with Covid than with getting the shot. To be honest I would recommend the shot even if just to prevent potential month-long loss of smell, as I experienced it (I think that symptom is less prevalent with recent variants though, but I could be mistaken)

> I think the risks of lying in a hospital, strapped to a ventilator

Being managed by medical professionals with no experience or training on said ventilator or enough personnel to accurate monitor the ventilators or even put the right people who actually need a ventilator and not just everyone that walked in the door.

Yes, hospitals were woefully unprepared in many cases, and there certainly were errors in proper care. That doesn't mean though that all or even most uses of ventilators were wrong.

Even with the shots I had 2 weeks where I could not smell.

Definitely one of the strangest things I've had happen to me.

To be honest I'm actually not sure what the numbers are when it comes to preventing that particular symptom. It was just the most annoying one to me personally. In case the vaccines don't prevent it in any meaningful way after all I simply recommend them to prevent, unlikely but possible, severe cases and death.

I think the use of ventillators was deemed overzealous and reactionary before we even had a vaccine rollout.

Covid gave me a fever for two days. The vaccine gave me a fever for two days. I don't see how either was better/worse than the other in my case.

The people who couldn't breathe certainly appreciated the ventilators. Possible that some were hooked to them unnecessarily, but certainly not all of them.

Do you think that your personal experience of covid automatically means that everyone else's was, is, and will be, exactly the same? Or can you accept that there is a bell curve distribution of possible physiological responses to a covid infection?

Perhaps society should consider homelessness a solved problem because you personally have a home?

"Going back at least as far as the polio vaccine, which was widely released to the public in the 1960s, we’ve never seen a vaccination with long-term side effects, meaning side effects that occur several months or years after injection."

https://wexnermedical.osu.edu/blog/covid-19-vaccine-long-ter...

Reply on news.ycombinator.com