The current SARS-CoV-2 pandemic and associated Covid-19 disease continue to cause major problems. In recent months, it has become apparent that many with the disease (early evidence suggests at least 10%) will not make a complete recovery but suffer from post-acute COVID-19 (so-called ‘long Covid’).¹ One of the features of long Covid is persistent, moderate to chronic fatigue. Not a great deal is known about how to best manage this.² It is possible that existing methods of managing post-viral fatigue, as well as approaches used in myalgic encephalomyelitis, will be applicable to long Covid. It may also be the case that approaches from psychiatry can be successfully applied to target fatigue.
Fatigue is a well-documented feature in many psychiatric illnesses. The biological basis of fatigue may differ between diseases; the often-debilitating effects remain fairly consistent. While unproven yet, it is conceivable that psychostimulant drugs could be of use to individuals suffering from chronic fatigue as a result of long Covid. Targeting the symptom of fatigue through temporary use of lisdexamfetamine or methylphenidate could offer some respite for long Covid patients and lead to higher quality of life, until more efficacious treatment options are available. The Rochester Center for Behavioral Medicine has had success with a small open label trial of lisdexamfetamine in 30 patients with Long covid.
Recent contributions² argue that ‘priority’ should be given to understanding post-acute Covid-19 fatigue and emphasise the need to ‘explore pragmatic relatively low-cost techniques to treat post-viral fatigue’. It is also very possible that the wakefulness agent modafinil could serve as a safe and effective intervention. In post-stroke fatigue, modafinil use leads to a decrease in fatigue and improved quality of life compared with placebo.³
While there are of course risks with this class of drug, on balance it may be a risk worth taking (or at least investigating further). These drugs should form part of a broader, multisystem rehabilitation model and recovery framework, which also gives due consideration to patient pathology.
Beyond pharmacological approaches, there may also be other takeaways from psychiatry. Psychotherapies such as cognitive behavioural therapy can play a role in helping patients cope with the fatigue feature of mood disorders.
Given its variability in presentation, a patient-centric and symptom-specific approach should be taken in managing post-acute Covid-19. As such, we must be constantly looking across all areas of medicine for treatment options.
Laurence Wainwright
Oxford, England UK
Footnotes
Disclosure: The author reports no conflict of interest. The author alone is responsible for the content and writing of the paper.
ORCID iD: Laurence Wainwright 
https://orcid.org/0000-0002-5771-3496
References
- 1. Greenhalgh T, Knight M, Buxton M, et al. Management of post-acute covid-19 in primary care. BMJ 2020; 370. [DOI] [PubMed] [Google Scholar]
- 2. Perrin R, Riste L, Hann M, et al. Into the looking glass: post-viral syndrome post COVID-19. Medical Hypotheses 2020; 144: 110055. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Bivard A, Lillicrap T, Krishnamurthy V, et al. Modafinil in debilitating fatigue after stroke a randomized, double-blind, placebo-controlled, cross-over trial. Stroke 2017; 48: 1293–1298. [DOI] [PMC free article] [PubMed] [Google Scholar]