Long Covid Related Fatigue Linked to Anxiety and Depression

Author: Universitat Oberta de Catalunya (UOC) - Contact: uoc.edu
Published: 2022/07/20 - Updated: 2023/01/04
Peer-Reviewed: Yes
On This Page: Summary - Main Article - About/Author

Synopsis: Researchers show there is a link between fatigue, depression, anxiety, and other cognitive deficits in patients with post-COVID-19 syndrome. The most common symptoms of the post-COVID-19 condition known as long Covid include fatigue, shortness of breath, and cognitive dysfunction. To be considered symptoms of long COVID, they must be present for at least two months during the three months after the onset of the disease. Fatigue is excessive tiredness and physical and/or cognitive and muscular weakness. It has been associated with conditions such as post-viral infection and neurological diseases.


Long Covid

Long COVID is called by many names, including post-COVID conditions, long-haul COVID, post-acute COVID-19, post-acute sequelae of SARS CoV-2 infection (PASC), long-term effects of COVID, and chronic COVID. Mild or moderate COVID-19 lasts about two weeks for most people. But others experience lingering health problems even after the fever and cough go away and no longer test positive for the illness.

The World Health Organization (WHO) defines post-COVID-19 condition (WHO's term for long COVID) as coronavirus symptoms that persist or return three months after a person becomes ill from infection with SARS CoV-2, the coronavirus that causes COVID-19. Those symptoms can include fatigue, shortness of breath, and cognitive problems (thinking and memory).

Other long COVID symptoms may include:

  • Joint or muscle pain.
  • A rash and/or changes in the menstrual cycle.
  • Digestive symptoms, including diarrhea and stomach pain.
  • Heart symptoms or conditions, including chest pain and fast or pounding heartbeat.
  • Blood clots and blood vessel (vascular) issues, including a blood clot that travels to the lungs from deep veins in the legs and blocks blood flow to the lungs (pulmonary embolism).
  • Neurological symptoms or mental health conditions, including difficulty thinking or concentrating, sleep problems, headaches, dizziness when you stand, pins-and-needles, loss of smell and/or taste, and depression or anxiety.

Long COVID symptoms can come and go but impact the person's everyday functioning and cannot be explained by another health problem. As of July 2021, long COVID, or post-COVID conditions, can be considered a disability under the Americans with Disabilities Act (ADA).

Main Digest

The Research Study

A team of researchers from the UOC and the Hospital de la Santa Creu i Sant Pau shows that there is a link between fatigue, depression, anxiety, and other cognitive deficits in patients with post-COVID-19 syndrome

The most common symptoms of the post-COVID-19 condition known as long Covid include fatigue, shortness of breath, and cognitive dysfunction, according to the World Health Organization (WHO). To be considered symptoms of long COVID, they must be present for at least two or three months after the onset of the disease.

A recent study in Brain and Behavior showed that the disease had a generalized impact on attention skills, executive functions, learning, and long-term memory. Furthermore, the scientific literature estimates that between 9% and 49% of patients present fatigue four weeks after the onset of symptoms, and it may even persist for a year in at least a third of patients.

Nevertheless, a possible link between fatigue and anxiety or depression in patients with long Covid had not been studied in laboratories. A study by the Universitat Oberta de Catalunya (UOC), published in open access format in the Journal of Neurology, has shown that fatigue in long Covid patients is related to anxiety, depression, and apathy.

"Persistent fatigue is very disabling and greatly limits people's quality of life. Suppose someone suffers from fatigue as a result of COVID-19. In that case, it's important to study this situation in further depth and to determine what other symptoms or disorders are associated with this condition," said Marco Calabria, lead researcher of the article, a member of the Cognitive NeuroLab group at the UOC and a member of the Faculty of Health Sciences.

According to the author, now that we know the link between fatigue and depression, "clinicians should explore these aspects to provide a focus for therapeutic guidelines." However, something that this research has not clarified is the direction of the effect: "it's unclear whether fatigue leads to depression or vice versa," he explained.

Scientists studied a sample of 136 patients with COVID-19 who were suffering from cognitive deficits eight months after contracting the virus. "We found that fatigue is linked to sustained attention, which we use to perform a task for a long period and which keeps us focused, and to executive functions, which enable us to temporarily store information to perform tasks such as calculating or reproducing a phrase that we've heard," said Calabria.

Studying Fatigue: A Clinical Challenge

Fatigue is excessive tiredness and physical, cognitive, and muscular weakness. It has been associated with conditions such as post-viral infection and neurological diseases. Nevertheless, although it could be broadly outlined in these terms, there is no universally accepted definition of this clinical condition, and knowledge of its underlying pathogenic mechanism is limited, which is why it represents a clinical challenge for experts.

Another challenge for the scientists was to separate post-COVID-19 fatigue from the consequences of the specific situation experienced during the pandemic.

"Fatigue is a symptom related to viral infections, and this suggested that it'd be one of the possible symptoms of SARS-CoV-2 infection," said Calabria, who believes that it is possible that, in the first waves of the pandemic, isolation may have contributed to the increase in some symptoms.

"But some observations tell us that this isn't always the case: fatigue prevents many people from going back to their previous lifestyle, while others continue to suffer from fatigue despite being able to return to pre-pandemic conditions, and we found that the prevalence of apathy associated with COVID-19 increased from 17% before infection to 62% after infection".

According to its authors, the study's results highlight the importance of a holistic approach when evaluating and considering a potential treatment for COVID-19 patients experiencing fatigue. However, there are still many unanswered questions: How are these changes reflected at the brain level? How long do they last? Who is more likely to suffer from these symptoms for a long time? What are the individual characteristics that predict recovery? We'll answer all these questions in the long term because this area's something new and unknown, concluded the researcher.


CALABRIA, M., GARCÍA-SÁNCHEZ, C., GRUNDEN, N. et al. Post-COVID-19 fatigue: the contribution of cognitive and neuropsychiatric symptoms. In: Journal of Neurology (2022).


27 Million COVID Patients May Have Long Term Smell and Taste Problems - BMJ - 27 July 2022 - Press Release

About 5% of adults may develop long-lasting changes to their sense of smell or taste after covid-19 infection, suggests research published by The BMJ. More than 550 million confirmed covid-19 cases to date means that at least 15 million and 12 million adult patients may experience long-term smell and taste deficiencies, respectively.

Given the huge impact that loss of smell and taste can have on the quality of life and general health, this could contribute to the rising burden of long covid, warn the researchers. Change in the sense of smell and taste is common in patients with covid-19, with 40-50% of people on average reporting these symptoms globally. But little is known about the clinical course of these symptoms or how many patients develop persistent problems.

To address this knowledge gap, an international research team trawled databases for studies of adults with covid-19-related changes to smell or taste and studies that described factors associated with these changes and time to recovery.

In all, 18 observational studies involving 3,699 patients met their criteria. Four of the studies were conducted in the community setting, and 14 studies in the hospital setting. The researchers then used a mathematical technique known as cure modeling to estimate self-reported rates of smell and taste recovery and identify key factors associated with the duration and likelihood of recovery. They found that smell loss may persist in 5.6% of patients, while 4.4% may not recover their sense of taste. At 30 days after initial infection, only 74% of patients reported smell recovery, and 79% reported taste recovery.

Recovery rates increased each month, reaching a peak of 96% for smell and 98% for taste after six months. Women were less likely to recover their sense of smell and taste than men, while patients with greater initial severity of smell loss and those with nasal congestion were less likely to recover their sense of smell. The researchers said one patient has yet to recover her sense of smell, even though it has been over 27 months since the initial infection. However, they note that the virus variant of SARS-CoV-2 was not reported in association with smell or taste recovery.

The researchers acknowledge several limitations in their analysis. For instance, the included studies varied in quality and relied on self-report, which they say "may overestimate recovery, suggesting that the true burden of olfactory dysfunction is even greater." However, this was a well-designed study with rigorous search methods, and the findings were unaltered after further analysis that excluded high-risk studies, suggesting that they are robust.

As such, the researchers say that while most patients are expected to recover their sense of smell or taste within the first three months, "a major group of patients might develop long-lasting dysfunction that requires timely identification, personalized treatment, and long term follow-up."

"Our findings are likely to be of substantial relevance to general doctors and otolaryngologists in the counselling of patients with smell and taste disorders post-covid-19," they conclude.

Health systems are unprepared for the scale of the challenge, warn experts in a linked editorial. They say, health leaders, policymakers, and research funders"

"Should realize the extraordinary importance of good chemosensory function for the wellbeing of humans, allocate adequate resources to support chemosensory research, and sustain medical specialists faced with an exceptional number of patients with smell and taste dysfunction."


This peer reviewed article relating to our Coronavirus Information section was selected for publishing by the editors of Disabled World due to its likely interest to our disability community readers. Though the content may have been edited for style, clarity, or length, the article "Long Covid Related Fatigue Linked to Anxiety and Depression" was originally written by Universitat Oberta de Catalunya (UOC), and published by Disabled-World.com on 2022/07/20 (Updated: 2023/01/04). Should you require further information or clarification, Universitat Oberta de Catalunya (UOC) can be contacted at uoc.edu. Disabled World makes no warranties or representations in connection therewith.


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