Fatigue, Brain Fog And A Racing Heart — What Doctors Are Learning About Post-COVID Neurodivergence

Forbes

16 hours ago

FAIRFAX, VA- February 3 : Eve Efron, who has been struggling with long covid for nearly a year, ... More frequently has to rest on the couch in her home in Fairfax, VA on February 3, 2022. She was denied temporary disability by Mutual of Omaha from her job at a PR firm after her doctor recommended she take time off. Her symptoms include significant fatigue, brain fog, anxiety and depression. (Photo by Carolyn Van Houten/The Washington Post via Getty Images)
Have you ever made people gasp by bending your knees backwards or touching your thumb back to your arm? Does your pulse race when you stand up? Do you have a history of gastric issues or irritable bowel syndrome? Are you also neurodivergent, by any chance?
There is emerging, but compelling, evidence that the overlap between neurodivergence, hypermobility syndromes, mast cell activation syndrome, postural orthostatic tachycardia and dysautonomia is not a coincidence, and has a lot to do with COVID.
The impact of these conditions can be severe on their own, though hard to diagnose and lacking in conclusive biomarkers. They lead to chronic fatigue, serious gastro-intestinal distress, brain fog and concentration difficulties, anxiety and depression. People drop out of the labor force, education and careers are curtailed. Prevalence rates are very hard to come by reliably, but estimates range up to 20% of the population affected by one or more of these conditions. Physicians have noticed that these diagnoses are also rising exponentially since COVID, which appears to trigger or exacerbate symptoms.
An Invisible Problem Hiding In Plain Sight
A special meeting at the Royal Society of Medicine (RSM) in London has concluded that neurodivergent people, who are more likely to have hypermobility, connective tissue and autoimmune conditions, have been disproportionately impacted by COVID, and that this is having a significant impact on our ability to go to school and work. The rise in neurodivergence since 2020 that is placing so much strain on education and health services, the tax payer and not forgetting the individuals themselves and their families, is indeed partly due to increased awareness and more accessible diagnostic criteria – as has already been argued. However, this does not explain why these high rates of diagnosis are accompanied by such vastly increased rates of school absence and inability to work. If neurodivergent people have always existed, why are we only now so unwell that we can't work?
The presentations to the RSM suggested that the effects of COVID on the brain could be contributing to the skyrocketing ADHD and Autism diagnosis waiting lists and to the absence epidemic. Since COVID we've needed to ask for help, whereas before we could fly under the radar.
Some people have dropped out of work or school altogether and are now battling to have their illness recognized. Others are still attending, but battling their own bodies, trying to force themselves to work through increasing difficulties with memory, unpredictable energy levels, pain, unstable pulse rates and various allergic inflammation. Their capacity for their work has been drastically reduced, they don't know why and try as they might to get better, it's not working. They are likely to be prescribed anxiety or depression medication in primary care and go looking for psychological answers to physical problems. Indeed, many of the markers we look for in diagnosing anxiety are, in fact, expressions of our nervous system – pounding heart rate, dizziness, hot / cold flushes. It is too easy to assign symptoms to stress and very difficult to identify the connections across the whole system.
The Solution Is Also Hiding In Plain Sight
It has taken a mixed group of medical experts in immunology, rheumatology, cardiology, urology, psychiatry and neuro-gastroenterology to connect the dots. At the RSM, they presented clear data indicating that for people with this overlapping group of conditions, neurocognitive and emotional symptoms have indeed increased. We're not making it up! Physical symptoms that were triggered by COVID infections have lowered our tolerance for sensory sensitivity in noise, smell, temperature, texture, light, food allergens, mould and all the toxicity in our environment. People who were neurodivergent a decade ago but coping in education and careers are now too ill to do so, and the effects of neuroinflammation could tip a sub-clinical neurotype into diagnosis territory.
The meeting further presented the extraordinary evidence that effective treatments for these issues are already available, such as anti-histamines, probiotics, mast cell stabilisers – simple, cheap, low risk medications which have made the difference between someone working and not working. One of the presenters, Dr Stephanie Barrett, MBChB, MD, FRCP, a Consultant Rheumatologist, reported that non pharmacological and non-invasive treatment such as repeated transcranial magnetic stimulation (rTMS) has also been found to be beneficial. She reports:
"RTMS (neuromodulation) was an extraordinary breakthrough for the treatment of depression. Now using a different protocol, we have shown that we can treat severe fibromyalgia with associated fatigue and dysautonomia, in patients who are stuck for decades in the pain/ fatigue prison.
The additional challenge for our patients is 80% prevalence of neurodivergence. All the complex physical conditions and associations are treatable but they need to be recognised first. We could set up hubs with the government, at low cost to treat all these conditions and return people of all ages to education and the workforce."
Each specialist presented various statistics, using many of the same treatments, indicating that a clear majority of their patients who were neurodivergent and unable to work before treatment are now back in work following an affordable protocol. Careers resumed, stories of people who feel they have 'got their life back'.
Believe People When They Say They Are Ill
In a country where productivity has dived since the financial crisis, and the health of the nation has not recovered from COVID, The Royal Society of Medicine are trying to understand the root causes, rather than paper over the end results. Neurodivergent people are at risk of losing their support from welfare payments due to changes to the benefits system, which could underrate the presence of multiple, mid-level symptoms, even though these all add up to a significant drain. Whilst political circles are arguing over the extent to which the population is malingering versus 'genuinely' ill, this group of physicians have come above the squabbling with a potential lever to tip the system from decline to healing. Following their proposed protocols, we can believe people who say that they can't cope, treat them and support their recovery to living a full life again.
Neurodivergent people of all ages have been stopped in their tracks, creating career and educational hiatuses that cause long term damage. We are at risk of a lost generation of working age people who cannot understand their fatigue, who are trying their hardest but just cannot get moving, the more they try the harder it is (see: post-exertion malaise). If you think you might be affected by any of these conditions, take an inventory of your symptoms, however disjointed they are, and talk to your primary care physician. Even if they can't refer you to a specialist, they owe you an explanation for your difficulties, so remember to be clear about what's happening. It is so easy to write off fatigue and poor concentration as 'stress' – but stress existed before the pandemic. If your capacity has changed, and you feel like it's increasingly hard to cope with work you previously enjoyed or found easy, then this could be a physiological problem and you should speak to your doctor.
Is COVID to blame for the rise in neurodivergence? The answer is complex. We have higher levels of awareness and improved diagnostic criteria. For children, we have failing schools where rigid curricula and draconian discipline disproportionately disadvantage neurodivergent children. In workplaces we have increasing demands for productivity rises and endless escalation of technology and surveillance. All this undoubtedly contributes to the absence epidemic, but all of it started before the pandemic. It doesn't fully explain the stark differences some studies showing that school absence has doubled from 2017 to 2023. The Royal Society of Medicine took some time to come at this problem from a less obvious angle, and in doing so have brought a cost effective solution into the light. It's time to stop assuming that people are lazy and time to stop putting multi-system health issues in the 'too difficult box.' As employers, as a country and as individuals with families to support, we can't afford to ignore the rising absence any longer.