Long Covid Complications

Long Covid, Depression and Anxiety

This just in: a report, from “Medscape Medical News”, on an article documenting the neuropsychiatric complications of Long Covid, especially the high rates of depression and anxiety.

The note was written by Sarah Novak and published on 10/10/23 (designation of this article as “news” is “iffy”, since the original article is more than 2 years old; but it’s worth a comment, anyway – vide infra).

To quote Ms. Novak, “It’s a surprising finding that shows that those with Long COVID complications may experience more mental distress than people with other chronic illnesses, such as Alzheimer’s disease, cancer, diabetes, and cardiovascular disease.”

I Disagree.

The findings reported in this excellent paper, regarding the neuropsychiatric complications of Long Covid, are not at all surprising – I can explain, but first, let’s take a look at the article in question:

The original article is an important, well-conceived, meticulously constructed and carefully reported, monumental study entitled “6-Month Neurological And Psychiatric Outcomes In 236,379 Survivors Of COVID-19: A Retrospective Cohort Study Using Electronic Health Records”, by Maxime Taquet, PhD, Prof John R Geddes, MD, Prof Masud Husain, FRCP, Sierra Luciano, BA , and Prof Paul J Harrison, FRCPsych, was actually published in the Lancet on 4/6/21.
If you’d like to read it yourself, see DOI:https://doi.org/10.1016/S2215-0366(21)00084-5

The study, derived from the TriNetX electronic health records network (>81 million patients, mostly in USA), compared 236,379 patients with a Covid 19 diagnosis (46,302 who were hospitalised and 190,077 who were out-patients), with 105,579 people with influenza, with 36,038 who had “any respiratory tract infection” and with people suffering from four other conditions (skin infection, urolithiasis, fracture of a large bone, or pulmonary embolism) diagnosed in the same time-frame.

The investigating group estimated the incidence, within 6 months after a confirmed diagnosis of COVID-19, of fourteen Neuropsychiatric Long Covid complications (“intracranial haemorrhage, ischaemic stroke, parkinsonism, Guillain-Barré syndrome, nerve, nerve root, and plexus disorders, myoneural junction and muscle disease, encephalitis, dementia, psychotic, mood, and anxiety disorders, substance use disorder and insomnia”) associated with long Covid. Individuals who had been diagnosed with any of these conditions prior to acquiring Covid 19, were excluded from the cohort under consideration.

In summary, the reported data show that COVID-19 is followed by significantly increased rates of neurological and psychiatric diagnoses over the subsequent 6 months: please see the graph below, which I copied from the paper because it summarizes this very complicated report and provides an excellent synopsis of the results.

Graphs, of neuropsychiatric complications of Long Covid 19, copied from the article.

Graphic Comparison, of psycho- neurological complications of Long Covid.
Neuropsychiatric Long Covid complications, by category. Creative Commons Attribution (CC BY 4.0)
my thanks to Elsevier’s open access license policy

Congratulations to the authors of the original study

The authors are to be congratulated on their efforts: this is an excellent analysis of the prevalence of Long Covid complications in the human psychoneurological system.

So, what do I mean by saying “I do not agree”?

In brief, there are no complaints to be made about the excellent paper by Taquet et al. There is nothing about it with which I disagree. Further, I agree with the general details, outlined by Ms. Novak, regarding the mental health effects of Long Covid, as discussed between herself and Dr. Anna Dickerman, a psychiatrist with New York – Presbyterian Hospital and Weill Cornell Medical College. Please do read Ms. Novak’s report, entitled “People with Long Covid Face Alarming Rates of Depression, Anxiety”, at
https://www.medscape.com/viewarticle/997209?ecd=WNL_mdpls_231013_mscpedit_wir_etid5947327&uac=235227EV&spon=17&impID=5947327 .

My objection is to the use of the word “surprising” – the findings outlined by Taquet et al. are not at all surprising: in common with all other stressful conditions, Covid 19 elicits a stress response, with elevated cortisol secretion, consequent intracellular T3 starvation (a.k.a. low T3 syndrome, nonthyroidal illness, and Intracellular Hypothyroidism) and resulting cellular “hibernation”. What is different with Covid 19, as distinct from other severe disease, is that the induced Hypothyroidism is deeper and more persistent because Covid 19 attacks several organs and metabolic systems simultaneously.

Chronic Intracellular Hypothyroidism

IH is in itself, stressful and therefore by itself, encourages continuation of the stress response.

In other words, chronic intracellular hypothyroidism, induced by the stress of Long Covid, self perpetuates because it, itself, produces stress. It will continue as long as stress persists, but can be relieved by exogenous Triiodothyronine, in slow-release format.

For an explanation of the above, see “Intracellular Hypothyroidism”, at https://www.researchgate.net/publication/370772568_INTRACELLULAR_HYPOTHYROIDISM, or at https://cbhrt.ca/2023/04/27/intracellular-hypothyroidism-ih/. Note that this is a rather long, in-depth dissertation on intracellular hypothyroidism. A much more concise note, regarding the diagnosis and management of IH, is available at https://cbhrt.ca/2023/06/05/t3-rt3-ratio/ .


IH, associated with the neuropsychiatric complications of Long Covid, is easily diagnosed via the T3/rT3 ratio and is eminently treatable. Oral (slow-release) triiodothyronine, titrated to elevate the serum FT3 to more than 4.5 pmol/litre, reliably relieves the hypothyroid symptoms.

I do not guarantee that treating a Covid/Long Covid victim for IH will cure the patient’s neuropsychiatric condition, although it may. However it will certainly eliminate the hypothyroid symptoms, which are the source of much of the patient’s misery, thereby improving quality of life and assisting with recovery.


Therefore I would suggest that a “full thyroid profile”, to include TSH, FT4, FT3 and reverse T3, be ordered for all those suffering from acute or chronic Covid (indeed, all chronic illness) and that those found to have a low T3/reverse T3 ratio (less than 20) should be treated with oral, slow-release Triiodothyronine, titrated to achieve a serum Free T3 between 4.5 and 6.1 picomoles/litre.

With this regimen, intracellular hypothyroidism is quickly, safely and reliably relieved, the patient’s quality of life improves markedly and his or her liability, to “autoimmune” syndromes and other conditions related to chronic hypothyroidism, are avoided.

CAVEAT: IH Must not be treated with T4 – T4 will be converted into reverse T3, making the situation worse.

Please feel free to visit CBHRT.ca: hover over “hormones”, then “thyroid hormones” and select the desired link.

I am a Toronto-trained Urologist. I practiced in downtown Toronto, from 1977 to 1997, when I went to Saudi Arabia as chief of Urology at the Armed Forces (teaching) hospital in Tabuk. Returning to Toronto in Y2000, I switched to family practice. In 2007, began to prescribe Hormone Restoration Therapy and in 2012, I became a member of the American Academy of Antiaging Medicine [A4M]. I successfully wrote the A4M's written examination in December, 2013 and In May, 2016 I passed the oral examination, for accreditation as a BHRT consultant. In 2014 I began BHRT practice in Collingwood, Ontario and in January, 2017, joined the Stone Tree Naturopathic Clinic. Now I am 82 and have retired, but it seems wasteful to jettison my learning and experience: the medical establishment knows nothing of BHRT / Functonal medicine and I feel obliged to offer my knowledge in the interest of those who are willing to think outside the box. MY QUALIFICATIONS: MB, BS, (from UWI), 1964. LMCC 1969. FRCSC (Urology), 1974. ECFMG 1984. Florida license 1998 [inactive], ABAARM Certification [A4M], 2016. I am a Member of CSAMM [the Canadian Society for Aging and Metabolic Medicine], the OMA&CMA, SUSO, CUA, RCP&S/C. PRACTICE TO DATE: Consultation in Functional Medicine, including assessment of Chronic Fatigue Syndrome, Fibromyalgia, Andropause, Menopause, Teenage and Postpartum Depression/Panic Attacks, Thyroid Hormone malfunction, Infertility, Sexual Dysfunction and “the Undiagnosable”. ALL ARE WELCOME to read, comment or question!

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