Post-COVID19 depression is a mood disorder that affects many COVID19 survivors and can involve relatives and healthcare workers. It is diagnosed using DSM-5 criteria and symptoms usually start after infection and can last weeks to months. Factors like severe initial infection, previous psychiatric conditions, and social isolation increase risk. Investigations aim to exclude other medical causes, and treatment involves psychotherapy, antidepressants, and other therapies like ECT. Preventing post-COVID19 depression focuses on early COVID19 treatment, managing preexisting conditions, and providing social and financial support.

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.