This week on Mind the Brain, Dr. Neill Epperson is joined by Drs. Thida Thant and Rose Mauch. Dr. Thant is the director of the University of Colorado Consultation-Liaison Psychiatry Service and the Psychiatric Consultation for the Medically Complex clinic. She has expertise in the evaluation and management of psychiatric symptoms in the context of medical and neurological illness. Dr. Mauch is currently a 3rd year psychiatry resident at the University of Colorado, and is interested in how long-term effects of early childhood trauma on psychiatric and medical illness. Together, they discuss a phenomenon many of us have experienced – a phenomenon called ‘pandemic brain.’ 

As consult liaison psychiatrists, Dr. Thant and Dr. Mauch work at the intersection of neurology, general medicine, and psychiatry—they look at the brain as it relates to all other areas of health, which gives them a unique perspective and clinical experience with patients battling or recovering from COVID-19. 

Defining pandemic brain 

Put simply, pandemic brain is a term used to describe the widespread adverse psychological effects caused by living through COVID-19. Dr. Thant describes it to Dr. Epperson simply, by saying “pandemic brain is the phenomenon that all of us are experiencing.” 

The population-wide decline in mental health and cognitive function Dr. Thant alludes to is evidenced by a screening of more than 300,000 adults by the U.S. Census Bureau, which found that, compared with 2019, American adults in the spring of 2020 were more than three times as likely to meet criteria for depressive disorders, anxiety disorders, or both.

It’s worth noting that the most severe manifestations of pandemic brain are found in socially disadvantaged Americans. Rates of depression and anxiety were highest among those with low savings and low income. A separate survey of 70,000 people throughout the pandemic confirmed what many have suspected—that “depression and anxiety are still highest in young adults, women, and people with a long-term physical health condition, people from ethnic minority backgrounds, and people living with children.” 

Tracking cognitive function and mental health in COVID and post-COVID patients

Post-COVID brain, unlike pandemic brain, is specific to individuals who contracted the COVID-19 virus. The symptoms of post-COVID brain are similar to those of pandemic brain, but typically more severe. The term was coined in late summer/early fall of 2020, when patients recovering from COVID were continuing to complain of cognitive dulling and emotional fatigue as long as 6 months after their infection. Dr. Thant’s Post-COVID Clinic/ post-COVID mental health program is studying the phenomena in real-time through multi-level screenings of COVID patients. While the data gathered thus far does indicate the existence of post-COVID brain, it’s challenging to quantitatively measure cognitive and mental health changes in patients, given the lack of baseline (or pre-COVID) function data. 

Dr. Mauch identifies COVID patients with pre-existing mental illness or pre-existing deficits in cognition as those vulnerable to post-COVID brain. Infection stigma, continued social isolation, and routine and/or sleep disturbances can also make post-COVID patients more vulnerable to mental health challenges after infection. 

The Role of Stress and Anxiety in pandemic and post-COVID brain 

Dr. Thant tells Dr. Epperson that while post-COVID patients screened for cognitive deficits often do display them, those deficits are sometimes less substantial on cognitive testing than the patient expects them to be—which Dr. Thant attributes to stress. She says, “In our post-COVID patients, it’s an interesting kind of cycle between ‘what are direct effects of the illness, and then what are the subsequent psychological sequela of dealing with the direct effects of illness?’” COVID’s adverse effects on cognitive function and mental health seem to be made worse by the stress caused by those adverse effects. 

Dr. Epperson explains that this makes sense, given that in the brain, stress (both general and acute) leads to decreased working memory and decreased cognitive flexibility. In someone accustomed to feeling sharp and quick minded, the brain fog they experience post-COVID would in many cases cause them frustration and stress—which would only further diminish cognitive function. 

Neurobiologically, this makes sense. “When the temporal limbic regions of the brain are active from being overwhelmed with worries and uncertainty,” says Raquel Gur, M.D., Ph.D., a professor of psychiatry, neurology, and radiology at the University of Pennsylvania, who has been conducting an international study of personal resilience during the pandemic. Under stress, It's harder for the part of your brain that lets you complete tasks to function. 

Similar neurobiological circumstances contribute to pandemic brain. “Chronicity, uncertainty, feelings of helplessness—these are not good for human beings,” says Dr. Epperson when describing the continued stress state that COVID has forced us all to live in. The continued stress and uncertainty lead to emotional and cognitive dulling, the experience of which Dr. Mauch finds to be described well by Adam Grant in an article for the New York Times. 

Living with post-COVID and pandemic brain 

Trying to return to daily life after a COVID-19 infection is significantly more challenging for patients with post-COVID brain, who, based on what Dr. Thant has seen in her clinic, often have “waxing, waning” symptoms. While staying stimulated and active can help stave of minor depression and anxiety post infection, staying stimulated and active can exacerbate post-COVID brain symptoms. She tells Dr. Epperson, “Some of our post-COVID patients’ symptoms get exacerbated when they try to exercise or return to work, [at least in the short term], which can be really demoralizing. They start to feel better, so they try to do more—and then plummet back to where they were.” 

Even for those who never contracted COVID, the experience of pandemic brain can be significantly challenging and disruptive to everyday life. Dr. Epperson asks her guests to offer parting wisdom and advice to listeners as we all continue to face these challenges. 

Dr. Thant closes the episode by telling everyone, “Give yourself a break. This is a message that came out early but that I think a lot of people forgot. It’s okay to have an off day, it’s okay to feel like you just can’t do something right now. It’s about balance.” 

Post-COVID Care

The University of Colorado has a multi-disciplinary Post-COVID Long-Haul clinic consisting of neurology, pulmonology/critical care, PM&R, cardiology, ancillary therapy and psychiatry. They provide comprehensive evaluation and management of post-COVID symptoms. Psychiatric services are consultative and include evaluation of neuropsychiatric symptoms, cognitive testing, brief medication management and virtual support groups for patients that required hospitalization. 

 • For external referrals to the multi-disciplinary clinic please fax referral to 720-848-0750. Internal referrals may be placed via Epic staff message to Thida Thant or ambulatory order for AMC Post COVID clinic.

• For external psychiatry referrals please send an encrypted email to thida.thant@cuanschutz.edu with name, consult question, contact information and insurance information. 

• For internal psychiatry referrals please send an Epic staff message with name and consult question to Thida Thant.

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Listen to the episode: Dr. Thida Thant and Dr. Rose Mauch on Pandemic Brain and Post-COVID Brain 

For additional support, explore all of our mental health resources.

 

Mind the Brain CME Information: 
CME Survey for the July 28, 2020 Edition

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