Background. Long COVID (LC) patients frequently suffer from neuropsychiatric symptoms, including depression, anxiety, and chronic fatigue syndrome (CFS), relabeled as the physio-affective phenome of LC. Activated immune-inflammatory pathways and insulin resistance key play a role in these physio-affective symptoms due to LC. Aims: To examine the associations between the Hamilton Depression (HAMD), Hamilton Anxiety (HAMA) and Fibro Fatigue (FF) Rating Scale scores and serum C-reactive protein (CRP), prostaglandin E2 (PGE2), galanin-galanin receptor 1 (GAL-GALR1) signaling, insulin resistance, insulin-like growth factor (IGF-1), plasminogen activator inhibitor-1 (PAI1), and damage biomarkers such as S100B and neuron-specific enolase (NSE) in 90 subjects 3-6 months after acute SARS-CoV-2 infection. Results. LC patients show higher HAMD, HAMA, and FF scores, CRP, PGE2, GAL-GALR1 signaling, insulin resistance, PAI1, NSE, and S100B than participants without LC. The HAMD/HAMA/FF scores were significantly correlated with PGE, CRP, GAL, GALR1, insulin resistance, and PAI1 levels, and a composite score based on peak body temperature (PBT) - oxygen saturation (SpO2) (PBT/SpO2 index) during the acute infectious phase. A large part of the variance in the affective and CFS symptoms (33.6%-42.0%) was explained by a combination of biomarkers; the top-3 most important biomarkers were GAL-GALR1 signaling, PGE2, and CRP. Inclusion of the PBT/SpO2 index increased the prediction considerably (55.3%-67.1%). The PBT/SpO2 index predicted the increases in GAL-GALR1 signaling. Conclusions. These findings suggest that the affective symptoms and CFS of Long COVID are largely the consequence of activated immune-inflammatory pathways, metabolic aberrations, and the severity of the inflammation during acute SARS-CoV-2 infection.