Mental health changes following SARS-CoV-2 infection have been a significant public health concern. Many people who recover from the acute illness report new or worsened psychological distress, including episodes that resemble panic attacks. Researchers have investigated whether the virus establishes a biological connection to the subsequent development of anxiety disorders. Evidence suggests that a COVID-19 infection can directly cause or predispose an individual to debilitating anxiety attacks, extending beyond the psychological impact into physiological consequences.
The Confirmed Link Between Infection and Anxiety
Large-scale cohort studies confirm a statistically significant increase in anxiety disorders following SARS-CoV-2 infection. One analysis found that adults with a documented COVID-19 infection were approximately 46 percent more likely to receive a new anxiety diagnosis in the subsequent year compared to uninfected individuals. Other research showed COVID-19 patients were 1.26 to 2.13 times more likely to develop anxiety than those without a history of the infection.
It is important to distinguish between acute anxiety during the initial illness and chronic anxiety that emerges later. Acute anxiety can occur during the infectious phase due to fear, isolation, and respiratory distress. Chronic anxiety manifests weeks or months later as part of Post-Acute Sequelae of SARS-CoV-2 infection, often called Long COVID. This later-onset anxiety represents a pathological change rather than a simple psychological reaction.
Physiological Mechanisms Driving Post-COVID Anxiety
The biological basis for this increased incidence of anxiety lies in the systemic effects of the virus on the nervous system. The inflammatory response to SARS-CoV-2 involves the release of pro-inflammatory signaling molecules. These molecules can cross the blood-brain barrier, leading to neuroinflammation within the central nervous system. This inflammation can affect brain regions that regulate mood and fear, such as the amygdala and hippocampus, potentially altering the neural circuits responsible for emotional stability.
The infection also disrupts the Hypothalamic-Pituitary-Adrenal (HPA) axis, the body’s primary stress response system. Viral stress and inflammation stimulate the HPA axis, leading to increased production of the stress hormone cortisol. Chronic dysregulation or over-activation of the HPA axis can contribute to chronic hyperarousal, making a person more susceptible to generalized anxiety and panic attacks.
Furthermore, the virus can cause microvascular injury, damaging the smallest blood vessels. Endothelial dysfunction can lead to microclots and reduced blood flow to neural tissues. This compromised oxygen delivery and nutrient supply impairs overall neural function, contributing to neurological and psychiatric symptoms, including anxiety and cognitive dysfunction.
Differentiating Anxiety Symptoms from Physical Illness
A major challenge for individuals recovering from COVID-19 is distinguishing between the physical remnants of the illness and the somatic symptoms of anxiety. Many symptoms of a panic attack, such as shortness of breath, chest tightness, rapid heart rate, and fatigue, significantly overlap with residual post-viral symptoms. This overlap can create a vicious cycle where post-infection physical sensations are misinterpreted as a sign of imminent physical danger, triggering a full-blown panic attack.
A key difference lies in the nature and duration of the symptoms. Anxiety-induced shortness of breath is typically hyperventilation that resolves with focused breathing exercises or distraction. In contrast, respiratory distress caused by residual lung damage or post-exertional malaise is often persistent and less responsive to psychological coping mechanisms.
Similarly, chest discomfort caused by anxiety tends to be sharp, stabbing, and short-lived, lasting minutes until the panic subsides. The chest pain associated with physical post-COVID issues, such as lingering inflammation, may feel more like a persistent pressure or heaviness lasting for hours or days. Patients should also look for symptoms specific to physical illness, such as fever, cough, or a new loss of taste or smell, which are almost never present during an isolated anxiety attack.
Strategies for Managing Post-Infection Mental Health
Individuals experiencing new or exacerbated anxiety following an infection can take proactive steps to manage symptoms and improve their overall mental well-being. Establishing a consistent daily routine is helpful, focusing especially on sleep hygiene by maintaining regular bedtimes and wake times to help regulate the body’s disrupted HPA axis. Engaging in regular, gentle physical activity, such as walking or yoga, can also help reduce symptoms by modulating the body’s stress response and improving mood.
Specific techniques can be employed during periods of heightened anxiety or a panic attack. Controlled breathing exercises, such as diaphragmatic breathing, work to slow the heart rate and signal to the nervous system that the danger has passed. Mindfulness and meditation practices can also be used to cultivate nonjudgmental awareness of the present moment, which helps to decouple physical sensations from catastrophic thoughts.
If anxiety symptoms are persistent, overwhelming, or interfere with daily functioning, professional help should be sought. Cognitive Behavioral Therapy (CBT) is an evidence-based approach that teaches people to identify and challenge the thought patterns that trigger panic and fear. For more severe cases, a healthcare provider may suggest a combination of psychotherapy and medication, such as selective serotonin reuptake inhibitors (SSRIs).