Post-COVID Lung Damage Linked to Anxiety & Depression

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A new study reveals important connections between lingering lung damage after COVID-19 and mental health issues like anxiety and depression.

The research also demonstrates that simple at-home breathing exercises can improve both lung function and mood.

Key facts:

  • 1 in 3 patients in the study still had abnormal lung function 2 months after moderate COVID-19 illness. The most common issue was a restrictive lung defect.
  • Patients with lingering lung damage after COVID were nearly twice as likely to have new anxiety or depression compared to those with normal lung function.
  • The breathing exercise intervention (using an incentive spirometer) significantly improved anxiety and depression scores as well as lung function compared to regular care alone.
  • Older age was identified as a risk factor for both lung abnormalities and mental health issues after COVID-19.

This new data highlights the interconnectedness between physical and mental health when recovering from COVID-19.

It also points to the importance of addressing both pulmonary and psychiatric symptoms together.

Simple at-home breathing techniques could provide big benefits for those still struggling with long COVID symptoms.

The Physical Toll of Long COVID on the Lungs

As the COVID-19 pandemic stretches on, increasing focus is being placed on the lingering physical and mental health effects seen in many patients.

The lungs are one of the main organs affected by SARS-CoV-2 infection.

Prior studies found that weeks and months after COVID illness, many patients continue to experience shortness of breath, reduced exercise capacity, chest tightness and other respiratory complaints.

Previous research indicated that 39% of post-COVID patients had reduced diffusion capacity, 15% had restrictive lung abnormalities and 7% had obstructive lung defects.

These issues with gas exchange and lung function don’t just impact daily physical abilities – they can also take a toll on mental health.

In the current study published in Primary Care Companion to CNS Disorders, researchers in India aimed to evaluate both lung function and mental health in COVID survivors 2 months after their initial infection.

They enrolled 100 patients aged 18-65 who had persistent respiratory symptoms after mild-moderate COVID-19 illness.

Each participant completed pulmonary function tests (PFTs) using spirometry, a simple technique that measures how much air a person can inhale and exhale.

They looked for restrictive lung defects (reduced lung expansion), obstructive defects (airflow blockage) or mixed defects.

The results showed that a full 1/3 of patients (35 out of 100) still had abnormal PFTs about 8 weeks after their COVID-19 illness:

  • 33% had restrictive lung defects
  • 1% had obstructive defects
  • 1% had mixed defects

The researchers noted that tobacco smoking was more common in the group with lingering lung abnormalities.

This aligns with other evidence showing smokers are at higher risk for complications from COVID-19.

Those with pulmonary dysfunction after COVID also had significantly lower oxygen saturation – another metric that can impact energy levels and overall wellbeing.

The takeaway is that even mild-moderate initial infections can potentially cause persistent damage to the lungs that limits respiratory capacity.

And these subtle changes can be picked up through simple spirometry testing.

Higher Rates of Anxiety and Depression With Lingering Lung Damage

So we know from the first phase of this study that roughly 1 in 3 patients hospitalized for moderate COVID-19 still had impaired lung function 2 months later.

The next question was whether these respiratory issues are linked to any neuropsychiatric effects like anxiety or depression.

To evaluate this, the researchers used standardized rating scales for anxiety (GAD-7 and Hamilton Anxiety Rating Scale) and depression (Patient Health Questionnaire-9).

Patients were assessed for symptoms consistent with generalized anxiety disorder, panic disorder, or major depressive disorder based on established criteria.

The patients with abnormal PFTs after COVID-19 had a significantly higher rate of new-onset anxiety or depression compared to those with normal lung function:

  • 20% of patients with lung damage had new anxiety or depression
  • Only 11% of patients with normal PFTs had new anxiety or depression

This suggests nearly double the risk of developing these mental health conditions when post-COVID lung abnormalities are present.

It highlights the interconnected nature of the pulmonary and nervous systems.

The study also found that older age was associated with higher rates of both lung dysfunction and anxiety/depression among post-COVID patients.

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Patients with mental health issues had an average age of 42 vs. 30 in those without anxiety or depression.

Previous models have proposed plausible mechanisms for how lung diseases and anxiety/panic disorders reinforce each other.

Breathing challenges and low oxygen likely activate the brain’s threat response (“suffocation alarm”) – while anxiety-induced hyperventilation exacerbates respiratory symptoms.

It becomes a vicious cycle.

This study provides clear evidence that recently acquired respiratory dysfunction puts patients at higher risk of mental health struggles as well.

It underscores the importance of addressing both physical and emotional health together during recovery.

Simple At-Home Breathing Exercises Ease Lung Problems and Anxiety/Depression

In the second phase of the study, the researchers wanted to see if a simple at-home breathing exercise program using an incentive spirometer could improve outcomes for post-COVID patients with lingering pulmonary issues.

The 35 patients with abnormal PFTs were randomized to either 4 weeks of incentive spirometry exercises plus regular care, or regular care alone.

This handheld device provides visual feedback to the patient to promote slow, deep breaths.

The patients using incentive spirometry were coached to take 10-15 long, expansive breaths with the device every 2 hours during their waking hours.

Parameters like tidal volume and peak air flow are displayed on the device to provide real-time feedback.

After 4 weeks, the patients in both groups were re-evaluated using the same assessments of lung function, anxiety and depression as the start of the study.

The group performing home incentive spirometry breathing exercises saw significant improvements compared to regular care alone:

  • Median anxiety scores (Hamilton & GAD-7 scales) decreased significantly in the incentive spirometry group, but not the controls.
  • Median depression scores (PHQ-9) also declined in the breathing exercise group only.
  • 50% of the incentive spirometry patients saw their PFTs normalize after 4 weeks, compared to just 33% of control patients.

The researchers believe that by strengthening the breathing muscles and re-training the body to take slow, full breaths, the incentive spirometry provides dual physical and emotional benefits.

The breathing exercises likely reduce hyperventilation and activate the relaxation response in the body, which calms the threat signals between the pulmonary system and the brain.

Patients feel more in control of their breathing, which reduces anxiety and panic symptoms.

Other studies in patients with COPD and asthma have shown that pulmonary rehabilitation programs improve anxiety and depression as well as lung function.

This study indicates a simple at-home breathing exercise routine with incentive spirometry could provide similar psychosomatic benefits for post-COVID patients.

Key Takeaways: Mind-Body Connection Essential for Long COVID Recovery

This research clearly demonstrates important interconnections between the pulmonary and nervous systems that are critical for full recovery after COVID-19:

  • 1 in 3 patients hospitalized for moderate COVID-19 still had impaired lung function 2 months later, most commonly restrictive lung defects. This can significantly impact quality of life and energy levels.
  • Residual lung abnormalities after COVID-19 doubled the risk of new anxiety or depression compared to those with normal PFTs. This mind-body interaction must be addressed.
  • A simple incentive spirometry breathing exercise program significantly improved both lung function and mental health symptoms over just 4 weeks. Strengthening the breathing muscles provided physical and emotional benefits.
  • Older age was identified as the most significant risk factor for both post-COVID lung dysfunction and anxiety/depression.

As the pandemic persists, more young and middle-aged adults are struggling with persistent long COVID symptoms.

This research emphasizes the importance of evaluating both pulmonary and mental health challenges in these patients. The mind-body connection is essential.

Simple breathing exercises like those with incentive spirometers can be one low-cost, low-risk option to aid the post-COVID rehabilitation process.

More research is still needed to confirm these findings and establish optimal exercise protocols.

But addressing the interconnected physical and emotional toll together will be key for full healing after this virus.

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