Post-Covid: Anxiety and depression
If you are feeling stressed or anxious it can be hard to shut off troubling thoughts. The energy that worrying and anxiety expend can exacerbate fatigue. Similarly, if you are low in mood or clinically depressed, this will also worsen fatigue.
Most people experience anxiety at some point in their lives. Anxiety is the emotion we feel when we think we are under threat and cannot cope with a situation. Although unpleasant, anxiety can be very helpful in certain situations as it warns and protect us when we are in danger. Our body responds to danger by producing adrenaline which results in a ‘Fight-or-Flight’ response. Examples of anxiety symptoms that occur at these times are:
- Breathing more quickly to get more oxygen to the muscles
- Increased heart rate to increase blood flow to the muscles
- Increased muscle tension to be able to react quickly
- Digestion slows down
- Saliva production decreases, causing a dry mouth
- A release of adrenaline, which can cause trembling
- Sweating to cool the body down in anticipation of physical exertion
- The mind becomes focused on the threat or scans our environment or further threat
- Thoughts racing help to evaluate threats quickly
- Increased heart rate getting more blood to muscles ready for action
- Nausea/vomiting emptying stomach so not to waste energy on digestion
- Breathing quicker gets more oxygen to the muscles
- Sweating cools downs and makes your more difficult to catch
- Bladder urgency makes you lighter and more nimble
- Trembling/shaky means muscles ready for action
When the danger has passed, the body returns to a less anxious state. Anxiety may become a problem depending on how we are thinking about the situation. For example, we may think a situation is more dangerous than it actually is, or we may think a situation is dangerous, when in fact, there is no danger. It is also worth acknowledging that being ill with Covid may have caused you great anxiety because of the fear of what could happen during the acute illness or simply because you have realised that its effects can linger and still impact on your life months later. This is an entirely understandable response to such a worrying experience.
Our thinking, memories or worries can trigger the fight-or-flight response, which can result in us feeling even more anxious. Subsequently, anxiety can affect our behaviour. For example, if we feel anxious in a situation, we may want to avoid it. The problem with avoidance is that it does not enable us to find out if there was any real threat or danger. If we keep avoiding situations, we will start to limit what we do in our daily lives.
What helps? Relaxation
Allows physical and/or mental tension to be released. Tension is the body’s natural response to threat which can be useful, but it is important to learn to let it go. Relaxation helps to reduce tiredness, reduces pain, helps us cope with stress, improves sleep, and improves self-confidence. Relaxed breathing, progressive muscle relaxation, Tai Chi, and Mindfulness are just some of the ways that we can engage in relaxation.
Focusing on sleep
- Poor sleep is a common feature of anxiety and depression. Here are a few more tips for managing sleep:
- Avoid or reduce the length of naps during the day
- Engage in gentle exercise
- Limit stimulants like caffeine before bed And remember the sleep hygiene advice previously discussed:
- Do relaxing activities before bed – bath, milky drink, relaxing music
- Don’t take worries to bed - write them on a list to deal with tomorrow
- If not asleep within 30 minutes, get up and move to another room and do a relaxing activity until sleepy again
Gradually reduce the avoidance to activities which is a key part of anxiety. This involves starting to do things which cause you anxiety. For example - the thought of walking to the shops might cause anxiety. Break this down into smaller steps. Repeat each step until it no longer causes anxiety, then move onto the next step:
- Start by stepping outside the front door
- Try walking to the end of the garden path
- Walk around the corner
Depression and low mood
Depression is characterised by feeling sad, ‘blue’ and miserable and is quite common. It can have a serious impact on a person’s well-being, ability and motivation and it can increase fatigue. For some people, it might happen only once and pass quite quickly without any outside help. For others, depression may be more of a problem – it may last longer or come back multiple times – in these cases, it may require treatment. For people with physical health problems, it is normal to feel sad as you adjust to what has happened and changes in your life. This might be temporary, or it may persist depending on your situation.
What are the symptoms?
- Losing interest in things you used to enjoy
- Loss of motivation
- Poor sleep
- No appetite/over eating
- Feeling constantly tired
- Feeling tearful
- Lasting feelings of sadness
- Self criticism/guilt
One of the problems with depression is it causes people to stop doing activities which they need to do or activities which they would normally have enjoyed and had a positive effect on them and their lives. This may be exacerbated if you are struggling with fatigue. Creating a routine helps. It’s important to balance activities so you are doing things which have to be done but balancing them with things which are enjoyable. Break activities into smaller achievable goals – if you’ve been unwell you must start off slowly and gradually build things up Write down a realistic plan of what you are going to do each day
Recognise how you are thinking about things
Notice negative or self-critical thoughts Question the thought and how fair / helpful it is Using a thought diary to help capture and view thoughts objectively You can refer to a talking therapy service who can help you with these issues. NHS Cambridgeshire & Peterborough Talking Therapies is available across all of Cambridgeshire and Peterborough. You can find out more / refer yourself by phoning 0300 300 0055 or by following this link: NHS Cambridgeshire & Peterborough Talking Therapies
Advice on Post-Covid fatigue and pacing: www.rcot.co.uk/recovering-covid-19-post-viral-fatigue-and-conserving-energy
Sleep Foundation: www.sleepfoundation.org/sleep-hygiene/healthy-sleep-tips
How to get to sleep: www.nhs.uk/live-well/sleep-and-tiredness/ how-to-get-to-sleep
Relaxation techniques: www.getselfhelp.co.uk/relax.htm
What is mindfulness?: www.headspace.com/mindfulness
Every Mind Matters: Eat better, sleep better, move more, manage stress and low mood: www.nhs.uk/oneyou
Apps (Please be aware that some of these may have associated costs)
Insight Timer: www.insighttimer.com
Do you need to print this information?
A leaflet version of the information above is available here to print out: Fatigue.pdf 163KB