Guidance Statement for Mental Health Symptoms of Long COVID Announced by the American Academy of Physical Medicine and Rehabilitation

Today, the American Academy of Physical Medicine and Rehabilitation (AAPM&R) announced new guidance for diagnosing and treating common mental health symptoms of Long COVID.

Long COVID remains a long-term public health issue. Long COVID symptoms are varied, ongoing, and are often experienced in clusters. Millions of Americans suffer from Long COVID.

Mental health conditions are not the cause of Long COVID. Many patients have described being questioned about their Long COVID-related symptoms in a way that feels dismissive of their experience and/or mistakenly attributed to an underlying mental health condition. Long COVID-related mental health symptoms include depression, anxiety disorders, and PTSD. The COVID-19 pandemic caused or exacerbated anxiety, depression, and PTSD in some people, but these same conditions can also be a physiological symptom of Long COVID.

Individuals who experienced mental health conditions before acute COVID illness may find that their mental health condition has changed or worsened due to Long COVID. Long COVID can cause new mental health symptoms and can also worsen existing mental health conditions or mimic other Long COVID symptoms. A physiological response to acute COVID-19 may trigger some people to develop a mental health condition.

“There really is some nuance in looking at the mental health symptoms of Long COVID because Long COVID symptoms that are related to mental health can also exacerbate or mimic other symptoms of Long COVID, such as fatigue, brain fog, and sleep disturbances,” said Abby Cheng, MD, FAAPMR, author of the guidance.

Underserved, underinsured, and underrepresented patients tend to have a higher prevalence of many medical conditions, including mental health conditions before COVID and mental health symptoms related to Long COVID.

Traditional nonpharmacologic and pharmacologic mental health treatments, such as SSRIs, should be considered in tandem for treating mental health symptoms of Long COVID. Medication should be prescribed after considering comorbidities and other Long COVID symptoms. Some Long COVID symptoms may be worsened by the common side effects of some SSRI medications; however, the side effects could benefit other symptoms of Long COVID.

This guidance and the guidance released by SAMHSA were developed in tandem, with the PASC Collaborative’s guidance developed to be more clinician-focused and SAMHSA’s developed to be more patient-focused.

PM&R physicians see the whole patient AND the whole picture of the rehabilitation ecosystem and help individuals recover quicker and more fully. Because a multidisciplinary and interdisciplinary approach may benefit rehabilitation, AAPM&R convened the Multidisciplinary PASC Collaborative to provide best practices from established Long COVID clinics in caring for patients with Long COVID. The first consensus guidance on fatigue was released in August 2021 in the PM&R Journal, followed by guidance on breathing discomfort and cognitive symptoms in December, cardiovascular complications in June 2022, and pediatrics and autonomic dysfunction in September 2022. Guidance on neurological symptoms of Long COVID was released in May 2023.

The American Academy of Physical Medicine and Rehabilitation is the national medical specialty organization representing more than 10,000 physicians specializing in physical medicine and rehabilitation. PM&R physicians, also known as physiatrists, treat a wide variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles and tendons. PM&R physicians evaluate and treat injuries, illnesses and disability and are experts in designing comprehensive, patient-centered treatment plans. Physiatrists utilize cutting-edge as well as time-tested treatments to maximize function and quality of life. Since the beginning of 2021, AAPM&R has undertaken comprehensive efforts to support its call for a national plan to address PASC and the millions of Americans it affects.