“There is evidence that early treatment with fluvoxamine can positively influence the severity of the course in COVID-19 infected individuals.” Prof. Dr. Ion-George Anghelescu, Consultant Psychiatrist and Psychotherapist, Mental Health Institute Berlin, Germany

The environment created by the pandemic, regardless of the consequences of SARS- CoV-2 infection, has led to significant mental health challenges. Lack of routines, activities, relationships, and social opportunities threatened stability, and additional stressors further deteriorated mental health. Certain groups were, and still are, exposed to particular stressors: Health care workers face danger, emotional pressure, and physical stress; elders are cut off from their networks; immunocompromised individuals and families of young children cannot return to a more normal life; students miss classrooms and friends. “Vulnerabilities” in individuals and communities became more visible in the pandemic. The myriad reports of depression, anxiety, suicidality, substance abuse, domestic violence, and conflict are therefore not surprising.

Brain fog caused by COVID-19

In addition, there are the neuropsychiatric consequences of a SARS-CoV-2 infection. The direct influences of the virus on the central nervous system, combined with the immune response, lead to different clinical manifestations. Contributing factors include the different strains of the virus, numerous booster vaccines, and varying vaccination rates. Some affected individuals may experience significant neurological and psychological symptoms during acute COVID-19 infection, including depression, anxiety, and cognitive deficits. Many describe a “brain fog” (“brain fog”) characterized by reduced attention, decreased problem-solving ability, impaired executive function and decision-making. Even before fever or cough, delirium in older adults may also indicate COVID-19. Mood swings, confusion, and psychosis may be due to unrecognized, slowly developing hypoxia. However, there is evidence that early treatment with the antidepressant fluvoxamine in sufficient doses may positively influence the severity of the course in infected individuals.

Take an interdisciplinary view of long-COVID

Some patients report longer-lasting symptoms after COVID- 19 infection, commonly referred to as post-acute sequelae and, if persisting for more than four weeks, as long-COVID. It is not uncommon for preventive measures against SARS- CoV-2 to be justified on the basis of the syndrome. Common symptoms are depression, anxiety, cognitive impairment, sleep disturbances, headaches and sensorimotor complaints, but chronic fatigue is the leading symptom. In this issue (pages 28-32), Dr. Wolfgang Haus- otter takes an in-depth look at the phenomenon and the challenges in interdisciplinary diagnostics and therapy. For example, the pathophysiological processes are still the subject of research. However, initial results on biomarkers of long-COVID such as serological parameters and “handgrip strength” are already available. Such objectifiable variables are important for the nonspecific syndrome. For example, a 2021 study found that 50% of those with long-COVID had passed through the infection. This could not be demonstrated for the other 50%. To date, symptomatic therapy has been used. It remains uncertain whether the substances and vaccines effective against acute COVID-19 infection also help in chronic courses.