“If I could take one symptom away from all of [my long-COVID patients], I think that would be depression,” said Dr. Joseph Varon, chief of critical care and the COVID-19 department at the United Memorial Medical Center in Houston.

Long-COVID symptoms and physical deterioration are major contributors. Cognitive impairments—colloquially known as brain fog, fatigue, malaise, and debilitation—can impact a person’s employment and social well-being, further leading to stress and mental health problems.

“They get so concerned that their cognitive functions are not [at their] best, and that they have sleep difficulties,” he said.

People who have been suffering for a long time may face a crippling hopelessness that is difficult to recover from.

Psychiatrist Dr. Adonis Sfera relayed a story about his friend, who’s a surgeon in his 30s. Since contracting long COVID, he hasn’t been able to work for two years.

“He told me that walking makes him very tired and [he] feels depressed, thinking that he may never recover enough to be ‘like before,’” he wrote in an email to The Epoch Times.

“Some viral proteins can interact directly with human neural pathways involved in the processing of mood, sleep, or anxiety,” Sfera wrote in the email.

The feelings of anxiety, depression, loneliness, or helplessness may also be due to the biological imbalance that the disease causes.

Interestingly, he said these COVID-19 findings further support the concept that “the distinction between the body and the mind is imagined, not real,” as viral infections, which are something biological, can also affect the mind.

Sfera gave the example of tryptophan, which is an essential amino acid that individuals obtain through their diets. The body uses tryptophan to make serotonin, a neurotransmitter that can regulate a person’s mood.

Making serotonin from tryptophan requires angiotensin-converting enzyme 2 (ACE2), which is a receptor that regulates and maintains blood pressure.

But since SARS-CoV-2 binds to ACE2 receptors to infect cells, COVID-19 infections can block and deplete ACE2 activity, in turn blocking tryptophan absorption and the formation of serotonin.

“This is sufficient to induce depression and anxiety, even in the absence of psychological stressors of being ill, isolated, hopeless, or in pain,” Sfera said.

Tryptophan also activates a protein in the gut that regulates the composition of gut bacteria. When tryptophan is absent, this protein isn’t activated and can lead to diarrhea, inflammation, irritable bowel syndrome, and other gut-related symptoms.

Nevertheless, Sfera has found the drug to be very helpful in acute COVID and long-COVID mental health symptoms. He speculates that the drug not only helps patients mentally but also boosts their physical recovery.

The drug is approved to treat anxiety and depression as a selective serotonin reuptake inhibitor.

Varon said that among his recovered long-COVID patients, a common factor they shared was positive thinking and trusting that they would get better.

Psychiatrist Dr. Chloe Saunders, who’s a doctoral candidate and researcher at Aarhus University, related this way of thinking to the placebo effect—a beneficial effect produced by a patient’s belief in the treatment rather than the drug or procedure itself.

A trusting bond between a patient and their doctor can reap similar benefits for the patient.

When a patient perceives that a doctor is actually caring about them, “they actually start to improve physically [and] emotionally,” he said.

A major difficulty for some patients is forming this trusting bond, and they may need assistance.

“It’s quite inaccessible for a lot of people,” Saunders said. “They’ve never been taught how to do it. Things like trauma, body image, or body dysphoria get in the way of that as well.”

Saunders advises mindful activities under the sunlight in the morning and also before bedtime, encouraging making these activities a daily routine.

“The body needs this time to be in a relaxed state in the parasympathetic system,” she said.

This is why for the many who have never practiced mindfulness, reconnecting to the body may seem foreign and even intimidating, but Saunders believes that with guidance, everyone can unlock great benefits from grounding within their body.

The establishment of trust in recovery also includes counseling, forming support groups, or breaking mental habits that may cause mental stress.

As with all things, moderation is very important regarding the amount of bonding with others, as well as sensitivity to the body’s changes.