Post-Pandemic Depression & COVID-19 Mental Health Issues in 2021

Written by Gerard Bullen | Edited By Editorial Team

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Across the board, medical experts from different professional fields of research and study – from virologists and epidemiologists to psychiatrists and psychologists – are speaking together in unison, and are all predicting the same outlook for 2021: a significant and persistent negative mental health impact emanating directly from the coronavirus pandemic. 

As one published research study put it, we should be prepared for an “imminent tsunami” of post-viral depression and other mental health disorders and conditions.

When it comes to the coronavirus pandemic itself, there is now the proverbial light at the end of the tunnel – and, for sure, it’s been a dark and harrowing journey along that tunnel in recent months, too, with death rates as high as they have ever been since COVID-19 first landed on U.S. shores. Still, that light exists now, it lights our direction, with a number of vaccines now federally approved and currently being rolled out – however slowly.

“We have supply shortages and economic stress, fear of illness, all of our disrupted routines… There’s a real grief in all of that. We don’t have a vaccine for our mental health like we do for our physical health.” – Lisa Carlson, MPH, MCHES, renowned public health expert (2020)


woman looking at herself in the mirror

However, a mental health disorder, like major depressive disorder (or clinical depression, as it is often termed), doesn’t work the same way as a brand-new physical virus. You certainly cannot fast-track a vaccine, as has been achieved for the coronavirus, for the likes of depression or anxiety, or any other of the spectrum of mental health conditions that we are all susceptible to.

The continuing, knock-on effects of the COVID-19 pandemic – from the now vastly weakened U.S. economy to families whose “rainy day” savings have been utterly washed away by financial uncertainty, even hardship – those effects will still be with us beyond this year, and, certainly for a long while as a nation, we’ll be dealing with a “twindemic” – the virus itself, and the post-viral depression it is already creating right across the country.

As one mainstream media writer put it, “As the physical risks of the pandemic become better managed with vaccine progress, the mental darkness of the crisis will be harder to overcome.”

depressed man sitting on couch

What is Post-Viral Depression?

During and after the physical effects of a virus have passed, the inflammation and infection that has resulted can damage the lining of the central nervous system (CNS), allowing certain cells in the bloodstream that have fought the virus to pass into the brain.

These are known as “neuromodulators,” and they can affect the normal activity of neurotransmitters in the brain, resulting in feelings of fatigue and depression. If this depression is left unresolved, it can worsen and become clinical depression, also known as major depressive disorder (MDD).


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What is Major Depressive Disorder (MDD)?

MDD is a severe mental health disorder, which is characterized by a persistently depressed mood and/or a loss of interest in previously enjoyed activities, causing a prolonged and significant impairment in the sufferer’s daily life. Causes can be varied; however, research points to changes in the brain’s function and neural circuits.

The persistent sadness and disinterest of MDD can lead to a wide variety of both behavioral and physical symptoms, which can include:

  • Mood:
    • Anxiety
    • Apathy
    • Guilt
    • Loss of interest
    • Mood swings, or 
    • Sadness
  • Behavioural:
    • Agitation and irritability
    • Restlessness, or 
    • Social isolation
  • Sleep:
    • Excess sleepiness
    • Insomnia, or
    • Disrupted or restless sleep
  • Physical:
    • Excessive hunger
    • Fatigue (sometimes, severe), or
    • Loss of appetite
  • Cognitive:
    • Lack of concentration
    • Lethargy, or
    • Suicidal ideation (thoughts of suicide)

The primary treatment is usually medication, psychotherapy (often called “talk therapy”), or a combination of both, as research suggests that these treatments can normalize the brain changes associated with depression.

Map of the United States of America

The Mental Darkness: Why Do Pandemics & Epidemics Create Depression?

The various viral pandemics and epidemics that have become part of our global history have, in time, also become minefields of information and data for medical researchers – past and present. As the methods employed for such research improved, a number of valid ideas and propositions came to the fore.

One of these was the direct link that was becoming apparent between viral diseases among populations and the resulting decline in the mental health of those populations – the link between inflammation and mood disorders, such as depression.

1918 Flu Pandemic

Since the pandemic arrived here on our shores, comparisons have often been made to the 1918 influenza pandemic. However, the most relevant one hasn’t exactly become mainstream news itself and is only now being cited by those investigating the widespread decline in mental health being seen across those countries, like the U.S., heavily impacted by the COVID-19 pandemic. 

A recent article published in the Irish Journal of Psychological Medicine in May 2020), and entitled “Fallout from the COVID-19 Pandemic – Should We Prepare for a Tsunami of Post Viral Depression?*,” highlights one of more well-documented connections between viral pandemics and psychological stress – the direct inflammation-mood disorder link.

*Lyons, D., Frampton, M., Naqvi, S., Donohoe, D., Adams, G., & Glynn, K. (2020). Fallout from the COVID-19 pandemic – should we prepare for a tsunami of post-viral depression? Irish Journal of Psychological Medicine, 37(4), 295-300. doi:10.1017/ipm.2020.40

The article draws on the subsequent findings about the link since it was first raised by American psychiatrist Karl A. Menninger, who himself had been studying the 1918 Flu Pandemic. He was the first to urge his colleagues to “awaken from complacency” in relation to the emerging connection between the 1918 pandemic and psychiatric complications.

As Menninger reported then, “The frequency of mental disturbances accompanying the acute illness in the epidemic has been the subject of frequent comment, and the wave of psychiatric material that followed in its wake was unexpectedly large and correspondingly interesting” – it was a lesson learned over a century ago, and in exceptionally similar circumstances to today. 

The Direct Link Between Viral Inflammation & Mental Health

The Irish Journal’s article states, “Clinical or major depressive disorder interacts with disability and medical illness in a variety of ways that are complex – often with a bidirectional relationship. The development of mood disorders has been linked to inflammation, and the activation of inflammatory reactions… [induces] symptoms of mood disorders.”

Inflammation, a natural response to viruses like COVID-19, and mood disorders, such as the rising depression seen in 2020, are so intrinsically linked that the presence of one will induce the presence of the other – something we are witnessing more and more in recent months.

The article highlights this question, “While the negative psychological effects of prolonged quarantine measures may also seem obvious, does the recent outbreak of COVID-19 sweeping around the world potentially carry a second layer of psychological morbidity in the form of depression and mood disorder in its wake?” The answer they found is “Yes.”

The biological answer to “How is this possible?” is then explained, “In particular, decreased cellular immunity results in the formation of neuromodulators and [immunomodulating agents], which are hypothesized to penetrate the brain when the blood-central nervous system (CNS) barrier is compromised during time of stress, infection, and inflammation.”

In short, these neuromodulators inhibit our neurotransmitters, via our central nervous system (CNS), and so create feelings of depression and other negative responses, such as severe fatigue.

Other Post-Viral Conditions in 2021

It’s not just rising pandemic-driven depression that will be seen in 2021, unfortunately. There have been a significant number of cases of what has been termed “long-term coronavirus,” which bears a striking resemblance, in terms of ongoing symptoms, to chronic fatigue syndrome (CFS) – medically described as myalgic encephalomyelitis (or ME), which presents as extreme tiredness which worsens with physical or mental activity, that can’t be cured with simple rest, and has no underlying medical reason.

Additionally, according to a Northwestern Medicine health system study, over 80% of hospitalized COVID-19 patients display neurological symptoms. Even patients who have mild cases of coronavirus have reported memory loss, trouble focusing and other related problems that can last for months. Some experts state there is compelling evidence that the negative effects of the virus could last even longer, possibly creating a surge of cases of dementia and cognitive decline, often years down the road.


Post-Viral Depression: The Ideal Conditions

During 2020, the pandemic has resulted in profound changes to our way of living – personally, socially, and economically. It is these changes that have created the ideal conditions for worsening mental health to continue to worsen and lead to a significant spike in diagnosable cases of post-viral depression and other mood disorders.

Once the pandemic has finally been controlled by vaccines (and, undoubtedly, other health measures), the effects on our nation’s mental health will become the next public health emergency, and many of our current psychologists and psychotherapists across the diverse fields of mental health, including substance addiction treatment, will need to fundamentally refocus their professional care to encompass this.

Lisa Carlson, the immediate past president of the American Public Health Association and an executive administrator at the Emory University School of Medicine in Atlanta, recently stated, “We have supply shortages and economic stress, fear of illness, all of our disrupted routines… There’s a real grief in all of that. We don’t have a vaccine for our mental health like we do for our physical health.”

The conditions we currently have will provide an ideal environment for worsening mental health and an increase in the numbers of diagnosed depression (MDD) – these conditions include:

New Priorities for a Sedentary Culture: We find ourselves in a state of “sedentism” – defined as living in small groups permanently in one place – and our culture is a sedentary one, too, with far less daily activity than our predecessors. Furthermore, our priorities have gone about an abrupt change since the arrival of the pandemic, such as:

  • Prioritizing health
  • Dealing with financial hardship
  • Teleworking
  • Virtual homeschooling
  • Constant stream of new information
  • Isolation
  • Stress, and
  • Coping with sickness and death

Carlson believes the basics of life are now crucial: “to get sleep, to eat healthy meals, to move throughout the day, to spend time with pets and loved ones.”

Isolation Breeds Disorders: Those in recovery from substance use disorders (SUDs) and other mental-health related conditions are highly susceptible to worsening mental wellbeing. Opioid relapses, overdoses and drug deaths, which have spiked during the pandemic, are clear evidence of this. Additionally, for example, excessive hand washing and fears of contamination are both actual symptoms of obsessive-compulsive disorder.

Risks Heightened by Inequality: Many of the fundamentals needed to support mental health are directly linked to a person’s employment. Job loss can equate to losing health insurance, child care or paid sick leave, which directly impacts minorities, such as Black, Hispanic and Native American workers and their families. A North Dakota research professor recently stated, “I know of one [Native American] tribe where they have had multiple suicides between the ages of 20-40, leaving children to be raised by grandparents with no support for counseling for the kids or help for the grandparents.”

substance use after COVID

Effects of Rising Depression on Substance Use Disorder (SUD)

2020 – “The Year of COVID” – has provided many evidential instances itself about what happens when sufferers of substance use disorders face the further impact of high levels of depression, stress, and anxiety, especially when their normal routes to treatment, counseling, and support have been disrupted or curtailed.

Depression kills. Treatment works. Get help.” – Dr. Jordan Karp, Professor, and Chair, Department of Psychiatry, University of Arizona

Let’s look in particular at Pima County in Arizona, which had an exceptionally tough time in 2020 with the effects of the pandemic. For example, according to doctors from the University of Arizona College of Medicine’s Psychiatry Department, they are seeing an increasing number of patients battling mental health issues. In fact, the Pima County Health Department (PCHD) reported that, in 2020, there was twice the number of suicides in people aged 11-19 and those in their 50s, when compared to 2019.

Dr. Jordan Karp, University of Arizona Department of Psychiatry Professor and Chair, commented, “I think we are at the tip of the iceberg. Things may get more problematic in terms of rates of mental illness as we come into 2021. Psychiatric clinics are seeing an increase in activity, and we don’t want people to fall through the cracks.

Furthermore, Pima County saw unprecedented numbers of fatal drug overdoses in 2020. According to an official PCHD drug overdose alert, published on November 4th., there were a total of 337 fatal drug overdoses in Pima County in 2019. As of the first 9 months of 2020, there have been 334 recorded overdose deaths.

Mark Person, program manager for the Community Mental Health and Addiction Unit within the PCHD stated, “I can tell you today through our surveillance that we are already over 400 overdose deaths here in Pima County. The largest peak in the history of Pima County tracking this was the month of July when we had over 60 overdose deaths. That number in a given month is unheard of.”

Dr. Karp’s final comment is brief, to the point of being abrupt, but it is perfectly clear to all: “Depression kills. Treatment works. Get help.”

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Located in Scottsdale, Arizona, SpringBoard Recovery understands perfectly how your mental health is pivotal in recovering from substance addiction. It is intrinsic to our care and features heavily throughout our treatment programs here.

Contact us today to find out how we can help you break free from the chains of substance addiction, recover your state of mind, too, and begin to look forward to your deserved, substance-free future.


Author: Gerard Bullen

Gerard has been writing exclusively for the U.S. substance addiction treatment industry for many years, providing a range of medically-reviewed work, including white papers, long-form, and short-form content articles, and blog posts for accredited addiction treatment centers. A member of the American Medical Writers Association, Gerard’s specific focus is substance addiction (an area that has impacted Gerard’s personal life in several ways), and he is particularly drawn to the topics of professional, evidence-based treatment, new and alternative therapies, and enabling readers to find their own sustainable, long-term recovery. Gerard lives and works in Maryland, U.S., he’s happily married, and a proud father. His interests include hiking with the family, reading fiction (from the classics to virtually all of the current NYT bestseller list), American and British film classics, and his beloved dogs, Toby and Coco, both rescued from the local pound.

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