Description on post COVID19 depression, its diagnosis and management outline.

1. POST-COVID19
DEPRESSION
DR. MD. SAIDUZZAMAN (MUNNA)
MEDICAL OFFICER
DEPARTMENT OF NEUROLOGY,
MYMENSINGH MEDICAL COLLEGE
HOSPITAL.

2. COVID19 UPDATE (13/12/2021)
Worldwide: Affected- 270,488,382
Death- 5,324,116.
Bangladesh: Affected- 1,579,325
Death- 28,028.
Bangladesh is in 31st position in terms of death.

3. DEPRESSION
 Depression is a mood disorder that causes a persistent feeling of
sadness and loss of interest.
 It is diagnosed by DSM-5 criteria.

4. DSM-5 CRITERIA
 Depressed mood (subjective/observed)
 Loss of interest or pleasure.
 Change in weight or appetite.
 Insomnia or hypersomnia
 Psychomotor retardation or agitation
 Fatigue
 Worthlessness or guilt
Impaired concentration
Suicidal ideation or attempt.

5. POST COVID19 DEPRESSION
 Depressive symptoms among COVID19 survivors.
Significantly increases morbidity and mortality.
 Depression may involve others including relatives of
COVI19 patients and health professionals.
 May start immediately after infection and may persist
for weeks to months.

6. Psychiatric consequences of COVID19:
 Post-traumatic stress disorder (PTSD)- 28%
 Depression- 31%
 Anxiety- 42%
 Obsessive–compulsive symptoms- 20%

8. Predisposing factors:
 Severe acute symptoms.
 Previous psychiatric disorder.
 Prolonged hospitalization including ICU.
 Loss of family members and friends.
 Residual symptoms.
 Associated medical conditions.
 Social isolation and financial crisis.

9. PATHOGENESIS
 Post COVID19 depression occurs due to Neurobiological
Damage.
 It is the net result of-
- Systemic inflammation,
- Cerebral hypoxia,
- Neuroinflammation.

10. CONSEQUENCES..
 Reduced performances.
 Financial problems.
 Household crisis.
 Sleep disturbance.
 Suicide.

11. DIAGNOSIS
 Diagnosis is suspected on clinical backgrounds.
 Differentials should be excluded with appropriate
investigations.
 Suicidal ideation and attempts should be addressed
appropriately.
 Hospitalization may be needed in major depressive
disorder.

12.  Psychiatric evaluation- daily moods, behaviors and
lifestyle habits.
 Physical signs-
- Back pain
- Headache
- Joint pain
- Limb pain
- Gut problems

13. MEDICAL CONDITIONS TO BE EXCLUDED…
 Anaemia due to any cause
 Hypothyroidism
 Diabetes Mellitus
 Heart failure
 CKD
 Malignancy
 Drugs and toxins- Steroids, Alcohol.
 Critical illness myopathy and neuropathy.

14. INVESTIGATIONS
• FBC, PBF
• Blood sugar
• Chest x-ray
• Organ function tests- LFT, RFT, TFT
• ECG, Echocardiography
• CPK
• NCS and EMG

15. TREATMENT
 Timely referral to psychiatrist.
 Treatment options are:
- Psychotherapy
- Drug therapy
- Other therapies
 Psychotherapy includes- Cognitive Therapy, Behavioral Therapy,
Cognitive-Behavioral Therapy, Interpersonal Therapy.

16. TREATMENT…….DRUG THERAPY
 Tricyclic Antidepressants (TCA)- Amitriptyline,
Nortriptyline, Imipramine, Mirtazapine.
 Selective Serotonin Re-uptake Inhibitor (SSRI)- Sertraline,
Citalopram, Escitalopram, Fluoxetine, Paroxetine.
 Selective Norepinephrine Re-uptake Inhibitor (SNRI)-
Milnacipran, Levomilnacipran, Venlafaxine, Duloxetine.

17. TREATMENT…… OTHER THERAPIES
 Electroconvulsive therapy
 Transcranial Magnetic Stimulation (TMS)
 Deep Brain Stimulation (DBS)
 Vagus Nerve Stimulation (VNS)

18. PREVENTION
 Early treatment of COVID19 symptoms.
 Adequate treatment of associated medical conditions.
 Treatment of previous psychiatric conditions.
 Physical isolation, not social isolation.
 Psychological support.
 Financial support.