Long after the fever fades, something else lingers. For many, it isn’t exhaustion but a strange urgency—a compulsion to act, to fix, to do—followed by a sudden crash. Thought spirals, memory slips, moments of eerie detachment.
This isn’t simply anxiety. It’s not just fatigue. It’s the brain in survival mode, long after the danger has passed—haunted by signals it can’t yet quiet.
If you’ve felt this—a mind that feels foreign, a nervous system you can’t seem to regulate—you’re not imagining it. You’re living in the aftermath of a deep, physiological disruption. And it has a story to tell.
What’s Actually Happening in the Brain?
Researchers are still learning about the long-term neurological effects of COVID-19, but here’s what we know so far:
- Neuroinflammation: When the body’s immune system goes into high gear, it can cause lingering inflammation in the brain. That inflammation affects how clearly we think, how we feel emotionally, and how much energy we have.
- Nervous system dysregulation: Some people experience symptoms that resemble autonomic disorders—like heart palpitations, dizziness, or crashing fatigue. These can trigger anxiety or make the body feel constantly stuck in a stress response.
- Immune overactivation: Microglia, the immune cells in the brain, can stay on high alert long after the virus is gone, interfering with normal brain function and emotional regulation.
- Hormonal disruption: The stress regulation system—also called the HPA axis—can be knocked off balance, leading to mood instability, anxiety, and poor sleep.
The Emotional and Cognitive Cost
Many people with Long COVID report shifts in how they think, feel, and experience themselves—but those shifts don’t always fit into neat diagnostic boxes.
Some describe moments of intense, almost compulsive clarity—a sudden, urgent need to get everything done at once, as though the brain is firing on all cylinders but can’t sustain it. This can be followed by profound burnout or physical crash. Others notice their working memory is fragile, making it hard to hold thoughts in mind or follow through on tasks. These symptoms don’t always look like the typical “brain fog” that gets discussed—they can be sharper, more erratic, and harder to explain.
In this disorientation, it’s common to wonder: Am I developing OCD? Is this trauma? Why does my brain feel so unfamiliar? These are real questions. When your nervous system is dysregulated, it can mimic the patterns of other mental health conditions—like panic disorders, PTSD, or obsessive-compulsive tendencies—even if you’ve never struggled with those before.
People also report:
- Anxiety or panic that comes on suddenly, often without a clear psychological trigger—sometimes accompanied by a sensation of air hunger, where it feels difficult to get a satisfying breath even though oxygen levels are normal.
- Emotional flatness or a strange absence of feeling.
- Disconnection—from memories, identity, or bodily sensations.
- Brief sensory misfires—like hearing your name called when no one is there, or catching a glimpse of movement that disappears.
It can feel like your emotional and cognitive world is no longer your own—like your inner compass has gone haywire. But these symptoms aren’t signs of personal failure or psychiatric collapse. They’re signs of a nervous system that’s trying—and often struggling—to recalibrate.
What Can Help?
There’s no quick fix, but there are ways to support recovery—especially on the emotional and mental front. Here are some approaches that many have found helpful:
- Pacing: Learning to respect your body’s energy boundaries helps prevent the dreaded “crash.” Pushing through often backfires.
- Mindfulness and self-compassion: These practices aren’t about fixing or overriding symptoms—they’re about making space for your experience with gentleness.
- Therapy: Especially forms of talk therapy that can hold space for grief, disorientation, and identity changes. Psychoanalytic and psychodynamic approaches can be particularly useful when deeper themes get stirred up.
- Somatic (body-based) work: Techniques that help you tune into body sensations safely can support nervous system regulation and restore a sense of grounding.
- Cognitive supports: External memory aids, structured routines, and simplification strategies can help manage cognitive strain.
- Medication: In some cases, medications like SSRIs may be used to support emotional regulation while the brain and body recover.
You’re Not Making It Up
Long COVID is complex, and healing is rarely a straight line. But you are not imagining this—and you’re not alone in it. The effects on the brain and nervous system are very real, and they deserve to be taken seriously.
The mind and body are always in conversation. When we work with both—rather than trying to “power through” or minimize what we feel—we create the conditions for healing to unfold. It may be slow. It may look different than expected. But it is possible.
If you’re navigating the psychological effects of Long COVID and want support that honors both your emotional and physical reality, you’re welcome to reach out. I offer therapy sessions tailored to complex recovery processes—with space for the uncertainty, grief, and resilience this path requires.
