Long Covid Symptom: Severe Anxiety and Panic Attacks
- Dr. Brian Lum
- 4 days ago
- 10 min read
Updated: 3 days ago
Soon after the start of the Covid 19 pandemic, patients began experiencing severe anxiety. Some of these patients were quick to point out that they had experience with severe anxiety in the past and this was different.
The worst episodes were usually at night (from 9pm-4am) and the fear they experienced was debilitating. Many reported having the intense fear of never getting better again and that they would die. Unfortunately, many who reported this to their doctor were written off as having general anxiety.
I have specialized in chronic and complex illness for over a decade and while the Covid pandemic was new, post viral symptoms was not. For any major illness there will be pockets of the population that take longer than others to recover.
Complete medical investigations are imperative for those with Long Covid as there are often ways to speed up healing.
In this article you will find:
Why Long Covid can cause severe anxiety and fear
Potential mechanisms for why some Long Covid patients have severe anxiety
Effective functional medicine interventions to reduce anxiety in Long Covid patients
The information in this article and on this website are intended for informational purposes only and does not take the place of seeing a doctor and should not be used for the purposes of diagnosis. If you are experiencing severe symptoms, have chest pain, or have trouble breathing, go to a hospital right away. Consult a doctor before beginning or stopping any medications or interventions.
Personal Experience with Long Covid
Many of my family members contracted Covid in March of 2020 and while some recovered quickly, others developed Long Covid.
My experience in treating complex illness and my wife's skill in symptom mitigation were integral to us developing protocols for very sensitive patients that were unresponsive to more conventional treatments.
In the developed world, we are unaccustomed to virulent strains of viruses that sweep through the population quickly, claiming large numbers of victims. The flu can cause a fairly high number of deaths each season, but we are largely desensitized to those losses.
The specters of smallpox, yellow fever, and tuberculosis seem far removed from us even as some of these diseases still circulate around the world. It is a mistake to think that we cannot learn from the past or from other medical traditions. It is also a mistake to think that Long Covid patients are particularly unusual, are somehow weak or that there is nothing that can be done for those patients.
With a multi-faceted approach, a full resolution of Long Covid symptoms is absolutely possible and is a frequent occurrence in our practice.
Potential Mechanisms for Severe Anxiety in Long Covid
Long Covid Anxiety has been described as being 'different' from other kinds of anxiety and noticeably more severe. This may be because Long Covid symptoms are not localized - they affect multiples systems at once (such as the pulmonary, hematological, gastrointestinal and immune systems). [1]
Importantly, during the pandemic, anxiety was already very high in the general population. A study published in 2021 cited a meta-analysis involving 62382 participants, "in nineteen studies, stress was identified as the most prevalent mental health consequence (48.1%) of the COVID-19 pandemic, followed by depression (26.9%) and anxiety (21, 8%)." [2]
As we know that high levels of stress can exacerbate viral infections and make it harder to recover, the stress of the pandemic set the stage for many to have a harder time with the virus.
Exact mechanism for anxiety in Long Covid is likely a combination of different variables.
Hematologic, hypoxic, and inflammatory damages to the central nervous system, metabolic changes, and systemic inflammation due to the initial infection could all potentially be factors in ramping up anxiety, while high levels of histamine circulating in the bloodstream and nervous system can greatly amplify anxious thoughts and feelings. [3]
There is also a histamine component to Long Covid. When you move your body, you manually stimulate your lymphatic system of detoxification. This is necessary for health, but when recovering from illness, it can cause debris stored in your tissues to enter the blood and lymphatic system, triggering a release of histamine as your body tries to protect itself from what it perceives to be an invader.
Another potential cause is viral debris not effectively cleared from the body, this can stimulate the release of additional cytokines, which can perpetuate Long Covid symptoms. [4]
This debris material is often stored in the muscle tissue and lymphatic system. This may be why many of our Long Covid patients say that their anxiety, heart palpitations, and other symptoms get worse after physical movement (everything from running to just moving their arms while in bed all day).
We have also noticed Long Covid patients exhibiting a lower anaerobic threshold to physical activity - meaning it takes a lot less for the body to go from using oxygen to produce cellular energy to a state of making energy anaerobically (without oxygen).
This may be why patients often feel burning in their muscles only after a few steps or a few minutes of walking. They're body is producing excessive amounts of lactic acid - as if they just ran 25 flights of stairs. [5]
Three 'Hidden' Components of Long Covid
Most of my new patients have had Long Covid in the past or are dealing with it presently.
One of the patterns I notice is that there are three things that many of these patients have in common: biliary tree involvement, stomach lining inflammation and vagus nerve overstimulation/dysregulation.
The primary way the liver metabolizes toxins (including day to day cellular toxins) is through the bile system and eventually the digestive tract. For those with Long Covid, the body may have a more difficult time cleaning and clearing viral debris. This results in a 'traffic jam' in which the liver cannot properly dispose of the debris into the bile system.
Other systems of the body try to compensate but unfortunately end up contributing to increased symptoms. The stomach acid producing cells (parietal cells) can overreact and produce imbalanced amounts of stomach acid contributing to acid reflux, stomach irritability, and food intolerances.
The toxins that the liver just processed will hit the small intestines and since it wasn't adequately neutralized it can be caustic to the intestines and can produce digestive symptoms including additional food sensitivities.
The kidney and adrenal systems can change the hormones they excrete in effort to compensate for this detoxification crisis and as a result cortisol and adrenaline levels can rise. If the dysautonomia is severe, adrenaline and cortisol levels can be too high in one moment and way too low at another moment.
Any patient that presents with anxiety should be assessed for stomach lining irritation (gastritis). Healing the stomach lining is imperative for those with severe anxiety. Irritated stomach lining can cause the vagus nerve will be overstimulated, causing feelings of 'fight or flight.'
The vagus nerve is the primary nerve in the autonomic nervous system. It controls digestion, breathing, heart rate and our sense of feeling calm and at peace.
I had a patient describe Long Covid as feeling like they were a large bell that has been rung very hard - there was a constant feeling of overstimulation and even when the body was at rest, there was a 'hum' of inflamed nerves.
I approach each of these components differently depending on the patient. Since many Long Covid patients are sensitive, we often utilize foods to support bile flow - plain chicken and rice porridge (called congee) can be very nourishing for a compromised digestion and artichokes can stimulate bile flow.
Alcohol-free digestive bitters (we often recommend the Floradix brand) can also be very helpful. As with everything however, always check with your doctor, as you may need an even gentler approach.
Functional Medicine Interventions for Long Covid Anxiety
It is important that you are careful with yourself in your recovery and be mindful that it is common for Long Covid patients to have post-traumatic stress disorder (PTSD), either from the initial viral infection or from the resultant illness.
When you have a 'good day,' it can be very tempting to do as much as possible, but pacing is important; you will need to relearn your limits temporarily, as rest in this phase is crucial.
Histamine is naturally released at night and after meals, which coincides with the timing of peaks of anxiety and depression symptoms in many patients.
Identifying food allergies and sensitivities acquired due to infection and temporarily removing them from your diet is very helpful. There are also foods that can help your body to process histamine more effectively. Lowering levels of inflammation and oxidative stress can all have a dramatic effect on these severe symptoms.
We do this in a variety of ways which depend heavily on underlying health conditions, other symptoms present, and what we find in test results.
One of the most important considerations is to understand the role the mind has in symptom presentation. This is very different from saying something is 'all in your head.' The brain is incredibly powerful and there are very effective mind/body techniques that can reduce the severity of the symptoms of Long Covid.
Especially in the West, there is often a patient bias that for a 'big medical problem' there needs to be a 'big and powerful medical solution.' This causes many to devalue interventions like meditation, journalling, breathing techniques, qigong and mind/body techniques. If there was one area I wish all of my patients would focus on for optimal recovery, it is this.
These interventions are so effective that they are being implemented in a Harvard study for Long Covid patients. [6]
Books (particularly audiobooks if you have light sensitivity) can be very helpful as an introduction to mind/body techniques. The book, 'The Way Out' by Alan Gordon and Alon Ziv is pain-centric but can be applied to any lingering symptom.
The books by Dr. Claire Weekes ('Hope and Help for your Nerves' is one of them) can be very helpful. She was an Australian doctor who specialized in the treatment of post-traumatic stress disorder among soldiers after the First World War at a time when 'nervous illness' was largely ignored or dismissed by doctors at the time. Her audiobooks can be particularly great for feelings of panic.
Mindfulness techniques like Spring Forest Qigong, gentle yoga, and breathing techniques can also help to sooth an inflamed nervous system. Spring Forest Qigong can be done while lying down so it is accessible even for those with mobility issues.
Additional techniques and supplements can also be used and would be specific to an individual; these interventions would be determined at the time of an appointment.
Keep in mind that underlying imbalances - like nutrient deficiencies - can make anxiety symptoms much worse. It is important to get checked for things like Vitamin D and B12 deficiencies which can, when corrected, result in significant symptom alleviation.
Functional Medicine and Long Covid
Long Covid is still poorly understood; scientists and patients alike have only had a few years to experience and analyze the implications of this virus. This is why practitioners should be open-minded when it comes to unusual or uncharacteristic symptoms and be flexible in devising treatment plans for patients who become sensitive.
I only mention a few general interventions in this article; this is deliberate and is because there is no one 'protocol' or supplement that fits everyone.
Personalization is key to recovery and something I prioritize in every patient appointment.
Treatment options often depend on symptom severity, an individual's constitution, age, other symptoms, underlying conditions, and even the time of year.
Far too often, patients are being told that there is 'no cure' for Long Covid when recovery is absolutely possible.
Online Consultations Available
For over a decade, I have treated complex and chronic illnesses and patients who are sensitive to conventional treatments. This experience has informed the way I help all my patients but especially those who are experiencing Long Covid.
With functional medicine diagnostics and treatment options, scientifically supported mind/body practices, powerful natural supplements and specific and personalized application - anxiety symptoms in Long Covid patients can be reduced or eliminated.
I am currently accepting new patients and offer online consultations worldwide.
If you would like to schedule a free 15 minute consultation with me to ask questions about becoming a patient click the link below.
Histamine Course
In a few weeks time, we will be releasing 'Mastering Histamine Intolerance and Mast Cell Activation Syndrome (MCAS): A Complex Illness Specialist’s Guide.'
Please visit our page to sign up for our mailing list and, if you have time, to fill out our survey to help us make this course the best possible resource for you!
Written by Stephanie Lum and Dr. Brian Lum
Disclaimer: If you think that you may have a medical emergency, call your doctor or 911 immediately. No action or inaction should be taken based solely on the contents of this information. Nor should you ever delay seeking medical advice or treatment due to the information contained on this Website. The information on this Website is not intended to diagnose, treat, cure, or prevent any disease or medical condition. The information discussed is not intended to replace the advice of your healthcare provider. Reliance on the information provided by this Website, Dr. Brian Lum, or Functional Healthcare Institute is solely at your own risk.
Bibliography
[1] Silva Andrade, Bruno, Sérgio Siqueira, Wagner Rodrigues de Assis Soares, Fernanda de Souza Rangel, Naiane Oliveira Santos, Andria dos Santos Freitas, Priscila Ribeiro da Silveira, et al. 2021. “Long-COVID and Post-COVID Health Complications: An Up-to-Date Review on Clinical Conditions and Their Possible Molecular Mechanisms.” Viruses 13 (4): 700. https://doi.org/10.3390/v13040700.
[2] Tang SW, Leonard BE, Helmeste DM. Long COVID, neuropsychiatric disorders, psychotropics, present and future. Acta Neuropsychiatr. 2022 Jun;34(3):109-126. doi: 10.1017/neu.2022.6. Epub 2022 Mar 3. PMID: 35144718.
[3] Galán M, Vigón L, Fuertes D, Murciano-Antón MA, Casado-Fernández G, Domínguez-Mateos S, Mateos E, Ramos-Martín F, Planelles V, Torres M, Rodríguez-Mora S, López-Huertas MR, Coiras M. Persistent Overactive Cytotoxic Immune Response in a Spanish Cohort of Individuals With Long-COVID: Identification of Diagnostic Biomarkers. Front Immunol. 2022 Mar 25;13:848886. doi: 10.3389/fimmu.2022.848886. PMID: 35401523; PMCID: PMC8990790.
[4] Galán M, Vigón L, Fuertes D, Murciano-Antón MA, Casado-Fernández G, Domínguez-Mateos S, Mateos E, Ramos-Martín F, Planelles V, Torres M, Rodríguez-Mora S, López-Huertas MR, Coiras M. Persistent Overactive Cytotoxic Immune Response in a Spanish Cohort of Individuals With Long-COVID: Identification of Diagnostic Biomarkers. Front Immunol. 2022 Mar 25;13:848886. doi: 10.3389/fimmu.2022.848886. PMID: 35401523; PMCID: PMC8990790.
[5] van der Togt V, Rossman JS. Hypothesis: inflammatory acid-base disruption underpins Long Covid. Front Immunol. 2023 Apr 14;14:1150105. doi: 10.3389/fimmu.2023.1150105. PMID: 37122723; PMCID: PMC10140510.
[6] Beth Israel Deaconess Medical Center and Harvard Medical School Teaching Hospital. https://www.longcovidstudy.net/about
