We know COVID-19 can pummel the lungs. Once a COVID patient breathes freely again, it’s easy to assume the worst is past.

But a new study suggests the disease can have lasting neurological effects. Within six months of contracting COVID, one in every three survivors is diagnosed with a brain or psychiatric disorder, according to a study  in Lancet Psychiatry.

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Dr. Megan Donnelly

With more than 32 million cases of COVID reported in the U.S., these conclusions are alarming, no doubt. But treatments can help ease many of the symptoms. Dr. Megan Donnelly, a women’s neurologist at Novant Health Neurology and Headache - SouthPark in Charlotte, said she’s optimistic that research into COVID will reveal in the coming year much more about how the virus works for better targeted treatments.

Donnelly talked about neurological symptoms post-COVID, their effect on mental health, and what to do if you recognize these in yourself or your loved ones.

Do the results of the Lancet Psychiatry study about mental health or brain challenges post-COVID jibe with what you’re seeing in your own practice?

Yes. An editorial in The British Medical Journal also noted that “Covid-19 is likely to have important neuropsychiatric effects” both short-term and longer-term.

I would say the actual numbers are much higher for COVID survivors experiencing neurological effects post-COVID. Among other issues we’re encountering in patients are acute delirium or encephalopathy – which essentially means brain fog, confusion or general inability to focus.

Some post-COVID patients also report problems with fatigue and heart palpitations. What’s happening there?

You’re referring to a condition called dysautonomia, or disordered nervous system.

The nervous system has a lot of responsibilities, including maintaining our blood pressure and heart rate, so that when we stand up we don't pass out. Patients with dysautonomia get heart palpitations and fatigue. They may have problems with digestion. Chronic headaches are another common issue.

Some COVID patients found their sense of smell disappeared. Is that neurological, too? Can that continue for a long time? 

Yes, some patients experience longer-term loss of smell, known as anosmia, because of damage to the nerve cells of the nose. Others get parosmia, a disorder which causes them to smell funky bad smells, like smoke or feces, that aren’t really there. Some patients with either condition becomes depressed as a result.

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What’s the connection between sense of smell and depression?

Our sense of smell is closely tied to emotion. We think that’s because the sense of smell is located in the brain near the emotional and memory centers. If you mess up your sense of smell, there’s actually a pretty significant emotional impact.

Any other effects on the senses that can trigger mental health challenges?

Some patients report tinnitus, which is ringing of the ears. Tinnitus is seen very frequently in viral meningitis, and COVID can cause viral meningitis. Tinnitus and hearing loss can be quite debilitating.

Do people with post-COVID symptoms become depressed because they don’t feel well, or is there something about how COVID attacks the brain that leads to depression?

Probably both. There’s some component of loss of quality of life and the ability to do things you previously enjoyed, whether that’s holding down a job you liked or going out for jogs. Now maybe you don’t have the energy to run or to play as actively with your children.

In addition, there’s probably a neuro-biologic component. When the nerves are firing differently, there can be depression for that reason. We do know that happens with other medical conditions, such as stroke.

If somebody has a stroke, they can have personality changes or depressive symptoms literally because of the stroke alone and where it occurs in the brain. But sometimes it’s just because they feel really sad that half their body may not be working and they can’t do things they loved before.

Though these symptoms are scary, are you seeing that many patients eventually recover, especially with treatment?

There are definitely reasons to be hopeful. With loss of smell, 95% of people get better within six months. With fatigue, the majority of patients eventually feel better. We can provide supportive care. If a patient has excessive sleepiness, brain fog, headaches or depression, we can give them medications and other treatments to help.

I always recommend seeing your doctor. It’s also worth keeping in touch with the news on COVID research and therapies. Six months from now, a remedy might become available that isn’t today. I’m very optimistic because there’s an all-hands-on-deck mentality of everybody trying to figure this out.