Mixed Depression in the Post-COVID-19 Syndrome: Correlation between Excitatory Symptoms in Depression and Physical Burden after COVID-19

Abstract

The relationship between depression and post-COVID-19 disease syndrome (post-COVID-19 syndrome) is established. Nevertheless, few studies have investigated the association between post-COVID-19 syndrome and mixed depression, i.e., a specific sub-form of depression characterized by high level of excitatory symptoms. Aims of the present study are: (a) to compare the post-COVID-19 syndrome’s burden in depressed and non-depressed patients, and (b) to investigate the correlation between post-COVID-19 syndrome’s burden and the severity of mixed depression. One thousand and forty six (n = 1460) subjects with post-COVID-19 syndrome were assessed. Subjects were divided into those with (DEP) or without (CONT) depression. Sociodemographically, post-COVID-19 syndrome’s symptoms number and type were compared. In DEP, association between levels of excitatory symptoms and the presence of post-COVID-19 syndrome’s symptoms were additionally assessed. DEP showed greater percentages of family history of psychiatric disorders than CONT. DEP showed higher percentages of post-COVID-19 symptoms than CONT. A greater level of excitatory symptoms were associated to higher frequencies of post-COVID-19 syndrome’ symptoms. Higher levels of post-COVID-19 syndrome’s symptoms in DEP corroborate the evidence of a common pathway between these two syndromes. Presence of excitatory symptoms seem to additionally add a greater illness burden. Such findings might help clinicians choose the appropriate treatment for such states. More specifically, therapies aimed to treat excitatory symptoms, such as antipsychotics and mood stabilizers, might help reduce the illness burden in post-COVID-19 patients with mixed depression.

Neurocognitive Changes in Patients with Post-COVID Depression

“…Despite multiple reports on cognitive and depressive impairments [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 43 ] persisting for a year or longer after COVID-19 recovery [ 8 , 44 , 45 ], no studies have shown cognitive impairment in patients with clinically diagnosed post-COVID depression.…”

“…Simonetti et al [ 5 ] found an association between post-COVID-19 syndrome and mixed depression, i.e., a specific sub-form of depression characterized by a high level of excitatory symptoms. The group of depressed patients was formed only on the basis of the Hamilton scale.…”

“…To date, a large amount of evidence regarding cognitive and depressive impairments in post-COVID patients has been accumulated [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. SARS-CoV-2 infection is associated with an increased risk of developing mental disorders, including depression, which are detected both during the acute phase and in the post-COVID period.…”

“…A significant proportion of post-COVID patients report depressive symptoms as well as cognitive impairment [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 12 , 13 , 14 ]. In the published studies on post-COVID patients, data on cognitive impairment and depressive symptoms were mainly obtained through self-assessment questionnaires [ 6 , 7 , 10 , 11 , 12 , 15 , 16 , 17 ].…”

Demyelination in Patients with Post-COVID Depression

“…Some publications described differences in symptoms of PCD and MDD. Simonetti et al [17] found high level of excitatory symptoms in post-COVID-19 syndrome, which is more likely corresponded to a mixed form of depression. In contrast, the comparative analysis of biomarkers suggested a similar etiopathogenesis and inflammatory hypothesis for post-COVID depression and MDD [18].…”