Considerations for Treating Patients With Depression and COVID-19

(Part 4 of a 4-part series)

In this video, Jonathan E. Alpert, MD, PhD, of Albert Einstein College of Medicine and Montefiore Medical Center, New York City, New York, discusses special considerations for treating depression when patients have COVID-19. Dr. Alpert recently presented "Treating Depression with Other Medical Comorbidity" at the Nevada Psychiatric Association's 26th National Psychopharmacology Update.

Part 1: Dr. Jonathan Alpert on Medical Comorbidities in Patients With Depression
Part 2: Medical Conditions With High Rates of Co-Occurring Depression and Related Research Gaps
Part 3: Adapting Depression Treatment in Patients With Comorbid Medical Conditions

Read the transcript:

There are a number of considerations in treating depression in patients with COVID-19.

One, of course, is to understand the full biopsychosocial context, that the depression occurring during this time may be related to the illness itself and to medications, and also is in the context of severe disruption in people's lives—educational disruptions, vocational disruptions, social disruptions, financial disruptions. Certainly, as always in treating depression, we want to have a wide lens and think of all the factors contributing to somebody's depression.

We want to think about medication effects. Certain medications used to treat severe COVID infection, particularly hospital-level COVID infection, medications such as steroids, can have an impact on mood. It may still be necessary to use those medications, but one could be mindful of how other medications may be influencing mood, including depression, and the risk for hypomania.

We also want to think about the impact of the virus itself. We've certainly seen an increasing number of people who have what's sometimes called a long-haul form of COVID, which is to say that after recovering from the acute respiratory illness, they continue to have fatigue, malaise, cognitive problems, and sometimes some degree of depression.

We don't know exactly the contributing factors. Inflammation of the brain and other parts of the body may be part of that. We want to be open to understanding that COVID itself, the virus itself and the associated effects such as inflammation, may be causes of depression.

At this point, we are treating it similarly to how we treat other forms of depression, but we're also learning a lot and probably will continue to learn about how to target treatment of depression for people with postviral forms of depression.

Jonathan E. Alpert, MD, PhD, is the Dorothy and Marty Silverman University Chair of the Department of Psychiatry and Behavioral Sciences and Professor of Psychiatry, Neuroscience and Pediatrics at the Albert Einstein College of Medicine and Montefiore Medical Center, New York City, New York. He is also Chair of the American Psychiatric Association Council on Research. Before joining Montefiore Einstein in 2017, Dr. Alpert worked at Massachusetts General Hospital, Boston, for 24 years. His roles included Director of the Depression Clinical and Research Program and Associate Chief of Psychiatry. Dr. Alpert has received numerous awards for excellence in teaching and mentorship, scholarship, and patient care, and has authored more than 220 publications. His academic interests include treatment-resistant depression, treatment of depression with comorbid conditions, mental health disparities, ethical issues in research design, and medical education.