**5. Management of mental health issues related to post-COVID fatigue**

Depression, anxiety and stress are common mental health issues that have been identified in COVID survivors [28]. While these mental health conditions may not be directly linked to post-COVID fatigue, they commonly co-exist in the study population. These mental health disorders have been reported to be effectively managed using a combination of psychological and pharmacological treatment methods [29].

In the management of people with depression, literature suggests psychotherapy by psychologists or psychiatrists, as the first line of management [29]. This includes behavioral activation (helping the individual to identify and adopt new routines that could motivate or make them happy); and guide them in the process of identifying the major problems responsible for the health status, as well as self-developing solutions to these problems [30, 31]. Self-help materials can also be provided for these individuals to guide and foster the development of healthy behaviors [29].

Furthermore, it is important that healthcare professionals monitor these individuals during the process of healing, to ensure that they achieve their set goals [32]. Considering the residual fatigue post-COVID, it is important that the gradual return to activities is stressed. This will help them slowly adjust to the energy demand of activities, while this keeping their goals in mind. A sudden return to strenuous activities (which may be top on their list) may be very difficult, if not impossible for some of them to achieve. If not properly managed, this may demoralize the patient further, or in extreme cases lead to a sequela of other events. In cases where the symptoms persist or reoccur after psychological intervention, antidepressants are prescribed [33]. Cleare et al. [34] suggests that people who suffer from severe depression should undergo both psychological and pharmacologic management from the onset to achieve the best treatment outcomes.

While healthcare professionals await comprehensive research and reports on how to manage patients with long-COVID symptoms, it is imperative that we continue to use the available methods such as cognitive behavioral therapy (CBT), and peer support to management patients who suffer from mental health conditions due to the COVID experience [34]. People who report symptoms of anxiety should be asked about the exact reason or source of worry. Management of their condition should begin by addressing these worries. It is also important to educate patients on making treatment goals. Using these goals as a guide in helping patients during psychotherapy sessions, to ensure return to activity. Patients should be asked to make a list of activities they would like to return to. These activities should then be ranked based on the level of anxiety they cause the client. The healthcare professional should then advice the client to gradually commence their 'return to activity' with activities that worry them the least.

In addition, pharmacological means have proven to be effective in the management of anxiety in this population. Class of medications such as selective serotonin

#### *Mental Health Impact of Post-Infection Fatigue DOI: http://dx.doi.org/10.5772/intechopen.105813*

reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, benzodiazepenes, and gabapentinoids, among others have been successfully used in the management of anxiety [35]. Beyond the psychopharmacological treatment protocols, other conservative management techniques such as acupuncture, meditation, yoga, and exercise have been equally reported to be effective in managing anxiety in this population [35]. Exercises will steadily help to improve endurance, boost mood and improve immunity. Hence, I recommend exercises as an effective method of treating mental health issues in people with post-COVID fatigue.

Overall, due to the dearth of information on evidence-based techniques in managing mental health conditions in people suffering from long-COVID symptoms, mental health and rehabilitation experts have resorted to using the generally accepted methods to manage these conditions. So far, these are the best available approaches to help improve the quality of life of these individuals. However, it is necessary to view the patient holistically and take other symptoms (such as the co-existing fatigue) that the patients report into cognizance. This way, health care outcomes will be optimized. It is recommended that more mental health experts should carry out research to explore the effectiveness of various protocols in the management of mental health issues that are associated with post-COVID fatigue.
