The Long Covid Puzzle: From Brain to Body

[@MariaSotiropoulou88]

The way the video is made can be triggering for LC patients. Art can be incorporated with less dramatic editing, music, interviews and images. Keep that in mind next time if your videos are primarily for patients. Thanks for being an advocate🙏

[@PsychiatrySimplified]

It’s something I thought about when creating the video - thinking about the audience. We’ve got some other videos in a different style with minimal editing etc ; we kept this a bit more graphic. But I understand your point. Thanks for the feedback

[@00TimberDoodle]

@@PsychiatrySimplifiedI agree with the above comment. As someone with a lot of cognitive trouble this video was a bit hard to watch, I actually had to turn down the speed unlike your other videos ive seen. Thanks for another highly informative video.

[@pilarkrol]

Amen!

[@Roberto-Escobar]

Great job Doc. I healed from long covid understanding polyvagal theory and mind body syndrome. You did a beautiful job making the connection between the symptoms and how they relate to our physiology. Hope many see this video.

[@LonglingEriksen]

my doc says i got cfs, had covid too. Same symptoms. This video jump and changes so fast that it makes me tired. Cant focus on what is said. 3 brakes only to 9 min. I give up. But feel like it is the same.

[@PsychiatrySimplified]

Sorry about your experience. Wonder if you can slow it down? CFS and Long covid has an overlap. Recent studies have shown this. They have similar pathophysiologies. I've covered CFS in another video on this channel.

[@Nazula236]

The editing on the video is amazing, looks polished and very well made. It really adds to the fascinating topic being discussed!

[@toppdesignstt]

It is, but for someone like myself, struggling with LC symptoms, including anxiety, it's too much. It's too fast and too "flashy", adding the sound and flashing of the electric current, I've had to pause the video half way through just to catch my breath and calm down. I will need to attempt watching this again later. This format of editing may work for "normal" people, but is too dramatic, shock inducing, and exactly the type of trigger my brain can't process. And I say this sadly, as I really think the information contained in the video, from what I took away thus far, seems to be very informative.

[@Jonathan-mt9up]

“The benefits of gain-of-function experiments and the resulting knowledge outweigh the risks.” -Anthony Fauci, ‘Research on Highly Pathogenic H5N1 Influenza Virus: The Way Forward’, 2012

[@CatherineKatz-uc6kr]

Where can we get treatment please? Do you offer consultations?

[@trixiesilver4030]

I love the animation & explanations here. I finally got covid (day 12) & it’s still hell with the exhaustion, low mood, headache, lack of appetite & smell. I can’t imagine this not going away & hope I don’t have to, but I’ve had several patients with LC & know how devastating it can be. (I need to get back over to the Academy to that course.) Questions- What do you think about acyclovir for LC (neuro) support? A couple of recent reports (Stewart & Savage, 2024; German et al. 2023) suggest there might be some benefit. Also, I notice you didn’t mention trazodone for sleep, in particular for its a1 antagonism & possible anti neuroinflammation activity. Are there negatives that outweigh consideration for its use here?

[@PsychiatrySimplified]

Thanks for the feedback. Trazodone can be considered - I’ve mentioned alpha antagonism and noradrenergic antagonism. So based on the stages of sleep affects one can consider a number of options - one of which is trazodone. Re acyclovir - there is evidence - the issue is when the cascade of neuroinflammation has started in which case the anti viral may not address the multiple other pathophysiological mechanisms that occur with neuroinflammation.

[@00TimberDoodle]

Thanks for creating these videos. Ive battled ME for about 16 years and your videos are hands down the most concise informative videos on youtube. Please keep sharing your knowledge on this subject because as you probably are aware its largely up to us to gain knowledge and advocate for ourselves as even when doctors believe us, they are clueless how to treat us. When I have the mental clarity I read new papers trying to understand as much as i can, but my background is not medicine. I would love to see a video solely dedicated on treatment plans. There are so many chickens and so many eggs it's very confusing about what to try and tackle first. Perhaps even some videos on how to even navigate the medical system to get help. I live in canada, my doctor simply says it's not his area of expertise and wont do anything but run basic blood panels and then tell me I appear healthy. I know there is success in restoring some functionality with proper analysis and a targeted treatment plan constructed by a knowledgeable physician. But finding that level of attention seems impossible.

[@PsychiatrySimplified]

Thanks for your feedback. And I agree that there is success in getting patients back to recovery - some significant . So yes it’s possible as you say with a targeted treatment plan. I’ve tried to provide general principles in the videos but it’s such a heterogenous condition and requires amongst the most individualised of plans amongst conditions . This is partly the issue for many. So after reading this comment, I dictated a script going into slightly more detail - navigating pathways and I’ll see what I can make of it . In teaching for clinicians I’ve created a 7.5 course on neuropsychiatry where I cover case studies where I can show these aspects step by step - challenging to do it here to ensure that medications aren’t considered as generic applications for all individuals with long COVID or cfs. Thanks for the suggestion. I appreciate it

[@annabellegettingwell1531]

How do I find a neuropsychologist that knows how to treat this in Arizona? I’m currently taking the triple anticoagulant therapy to try to treat possible microclots because nothing else is making sense. I would be helped by having a professional who could take my 3.4 year long case and help me piece together proper treatment.

[@PsychiatrySimplified]

Neuropsychiatrist wouid be a better options. But key here is what domains need to be addressed. Triple therapy may not be able to address the more severe cases where cogntion, activity fatigue is present.

[@Junkitup]

Well spoken , easy to understand, thankz

[@PsychiatrySimplified]

Thank you 🙏🏼

[@sallyweiner4180]

Explains exactly what I’ve been going through for 11 months

[@PsychiatrySimplified]

Hope you feel better soon and get the treatment needed

[@AvashneMoonsamy]

​@@PsychiatrySimplifiedthank you this explains what I'm struggling with after covid ... Fatigue , body pains, internal vibrations and more since 2020 to date

[@inderbirsingh9711]

Very informative video. Linking the psychopharmacological concepts with clinical aspects. One question do alpha2 agonists work on amygdala indirectly to reduce hyperarousal via top down mechanism ?

[@PsychiatrySimplified]

Amygdala has a high concentration of noradrenergic neurons from the Locus coeruleus - clonidine targets these neurons directly and reduces NA tone. It doesn't potentiate top down by itself but at the milder - moderate ends reduction of hyperarousal improves PFC function - think the difference it makes when a person has a good night sleep.

[@inderbirsingh9711]

@@PsychiatrySimplified thankyou for the explanation. Got the query due to the animation of the alpha agonist graphic ib the video

[@PsychiatrySimplified]

I've done a separate video in alpha agonists and also specifically on clonidine and guanfacine.

[@charlesfuchs]

In other words, we are all fucked lol

[@PsychiatrySimplified]

I wouldn't say that. Individuals get better.

[@maple7432]

There are drug that are used off label for long covid like velnafaxine bupropion etc

[@charlesfuchs]

They get better but still have symptoms for years. @@PsychiatrySimplified

[@charlesfuchs]

Thats a just a coverup for depression and anxiety@@maple7432

[@PsychiatrySimplified]

Depends on which symptoms - also there is a range of improvement which depends on several individual risk factors. Duration of illness, severity etc. It's not dissimilar to many other conditons such as autoimmune diseases, inflammatory conditions, pain etc - some enter complete remission others can have a relapsing remitting illness.

[@MrJerryStevenson]

This video was very intense compared to the others.

[@PsychiatrySimplified]

Sorry could you explain in what way? You mean the animations etc?

[@MrJerryStevenson]

Oh it’s just a lot of information. I love studying this as I get sober. So I understand a lot that goes on with interactions with illicit drugs. This video goes into other systems and conditions very rapidly. So it was above my basic introduction to neuroscience. But I did understand but can’t remember it obviously.

[@PsychiatrySimplified]

@@MrJerryStevenson yes i think many of these concepts require revisiting over time - same for me as part of learning - its only after years with clinical practice, observations, repetition that things consolidate well. Its the nature of learning. Thanks for replying

[@MrJerryStevenson]

@@PsychiatrySimplifiedI would love a video on the silent benzo epidemic and active protracted withdrawal and dependence. Also, rehab facilities are literally ripping people off them.

[@PsychiatrySimplified]

I'll try my best - the last part might be a bit controversial?

[@Wds__99]

That's great and all, but what is the solution? We all know what the symptoms are.

[@PsychiatrySimplified]

Did you listen to the whole video? Also listen to the other one on POTS / CFS / ME - I outline treatment options .

[@jamescullen-657]

Hi Sanil, If hyper arousal is present, are there holistic methods (such as meditation, deep breathing, etc.) that can reduce the hyper arousal? Or once the hyper arousal is present in a patient, targeted medication treatment the only way to get hyper arousal to be reduced?

[@PsychiatrySimplified]

Yes meditation, deep breathing, psychotherapy, good sleep, mindfulness etc can. But one has to recognise when that isn't possible because the arousal is excessive. It's at that point medication may be needed. But also what happens is we use medication to bring down the arousal - ‘give control back and then medication can come off as person can use medication etc to calm down their hyperarousal state. I'll be doing a video soon on difference between anxiety, hyperarousal and agitation. In the mean time have a look at the video on medication on our channel I cover this

[@castalianightwish8751]

@@PsychiatrySimplified dear Dr Rege, I've been months out of the constant panic attacks post-covid, I am not on meds, I have good sleep hygiene, I have a restful sleep, but I still cannot walk much and feel always tired, due to oxygen not getting to the muscles (I have diagnosed SFN) and my calves hurt, in lactic acid build up style. I have pre-existing trauma and anxiety, my HRV confirms this despite my efforts with coherent breathing, grounding, laughter yoga, qi gong, etc. I have tons of mood swings and I am on the verge of crying almost all the time. Would, in my case, a short run of antipsychotics meds help lower my amygdala activation so that my body can function again please?

[@pvw3799]

those who took the apple juice have side affects

[@eriamhsl3841]

Nothing to do with apples. Lmao

[@pvw3799]

@@eriamhsl3841 ignorance of truths equals stupidity

[@eriamhsl3841]

@@pvw3799 whose truth? Don't talk about shit you know nothing about.

[@punyadhardas8840]

Excellent! Very informative, well presented and nicely edited! Myself being a Psychiatrist, am impressed with this beautiful presentation. Best wishes

[@PsychiatrySimplified]

Thank you 🙏🏻

[@catmando268]

Thank you doc👍👍👍👍👍.

[@PsychiatrySimplified]

Pleasure 🙏🏼

[@maple7432]

Very intresting.

[@PsychiatrySimplified]

It is interesting

[@billybattsshinebox8559]

So when you were saying about elevated noradrenaline levels as a symptom of long covid, isn't noradrenaline the same brain chemical that opiate addicts have a overload of when they are withdrawing from opiates and thats what makes them sick? So effectively long covid sufferers are also having some of the same symptoms that a heroin/codine/morphine addict would experience when withdrawing?

[@PsychiatrySimplified]

Very good point! Yes opioid withdrawal or alcohol withdrawal leads to sympathetic rebound - NA activity increase correct. Hence why lofexidine ( alpha 2 agonist ) and clonidine are used in reducing and preventing this withdrawal. Alcohol also had BZDs prescribed for this purpose

[@billybattsshinebox8559]

@PsychiatrySimplified I work in drug treatment and help mentor people with drug addictions,so when I saw this I was kinda shocked obviously lofexidine is used to alleviate withdrawal symptoms but usually you have to be monitored daily while on it for side effects,but I also saw naltraxone which is obviously a opioid blocker which is used either by implant ot tablets to give a opioid addict a safety net so if they were to take opoids they wouldn't work and they cant get high, so why would you need naltraxone if long covid sufferers have most likely never been opiate addicts? What part does it play?

[@PsychiatrySimplified]

Low dose naltrexone is used - immunomodulatory effects mainly via the TLR - 4 Receptor. It’s also mast cell stabiliser. Also low dose antagonism via Naltrexone can result in endogenous opiod rebound which can provide mild mood improvement , pain relief etc

[@billybattsshinebox8559]

@@PsychiatrySimplified really interesting all this stuff, anyway you've got yourself another sub i will look forward to more interesting content

[@PsychiatrySimplified]

Thank you 🙏🏻

[@Unknown-hr4wi]

Delusions… Hello, for the whole month i have had delusions about life and god and suddenly i woke up and it all went away, my diagnosis is drug induced psychosis i have had 3 psychosis 2 of them was because of drugs and 1 is because i went of medication too early. What do you think caused me having delusions and then it went away by itself? I dont feel like myself like i did before i was while being on abilify. I feel like i lack my social skills i dont speak so much anymore… what can i do? Should i switch my medication? I am scared to switch also but i also want to so i can be completley free of delusions, is there a good antipsychotic like abilify but stronger than it? All questions are welcome. Thank you

[@PsychiatrySimplified]

I'm not sure I understood this. You are on meds? Did the delusions go 1. With the antipsychotic 2. After a period after the drug was stopped without antipsychotic? Or something else

[@Unknown-hr4wi]

@@PsychiatrySimplified i am on meds. I was on meds while delusional, and then it disappeared the delusions while on meds

[@PsychiatrySimplified]

So it’s possible that the meds have treated it ?

[@Unknown-hr4wi]

@@PsychiatrySimplified yes but i was not delusional before i was on abilify, and then i got delusional again while being on it now its gone

[@Unknown-hr4wi]

@@PsychiatrySimplified ?

[@eriamhsl3841]

Very similar to cptsd

[@PsychiatrySimplified]

There is an overlap in terms of the trauma and inflammation.