Since the beginning of the global pandemic, vaccine developers have been putting their heads together on an end-solution, all the while public health officials were trying to grasp how to slow the spread. But a third set of players — psychologists — have also been working from the beginning to understand how a mental health crisis could put a wrench in it all.
When Annelise Madison, a PhD candidate in clinical psychology at the Ohio State University, was reading about the mental health implications of lockdowns (such as stress, depression, loneliness, and poor health behaviors) as the novel coronavirus was spreading in the early spring of 2020, she began to connect some dots. Even though a vaccine was far out of sight, she began to foresee the toll these mental health symptoms could take in the future.
Madison works in the Stress and Health Lab at the Institute for Behavioral Medicine Research at OSU. And her advisor, Janice Kiecolt-Glaser, an expert in psychoneuroimmunology, has been studying how mental health impacts the immune system for more than 30 years. Following the FDA emergency-approval of now two vaccines, the lab members submitted a multi-study review outlining what is known about mental health and well-being and how that affects the body’s response to vaccines.
You might have experienced this mind-body phenomena personally: moments where stress has weakened your immune system, like getting a cold after pulling an all-nighter, or succumbing to the flu after completing a hard race and intense training season.
And the acute stress caused by the pandemic has been unmatched. It’s been over a year now since the first reported case of coronavirus reached America. In addition to the fear of the virus itself, we’ve been dealing with the loss of more than 400,000 American lives, job loss, and isolation from friends and family. On top of that, there was a heavy presidential election, crippling wildfires, and the boiling over of racial tensions caused by years of unacknowledged systemic racism. It’s been a long year.
Although acute stress reactions are meant to be protective, when they are felt for long periods it can lead to long-term problems like chronic fatigue, depression, and immune disorders. And it can also affect the way your body reacts to vaccines — like the ones we’ve been waiting over a year for.
The researchers from the Stress and Health Lab hope their research can provide people a way to manage their stress and set themselves up for success when getting their COVID-19 vaccine. “Even in this time when it seems like everything is out of control, we do have control over taking the time to invest in our mental and physical health right now,” says Madison.
Behind the Research
To be clear, Madison’s lab has not studied either COVID-19 vaccine. The vaccines are just too new. But the lab is confident that based on what it’s seen with past vaccines that the precedent would remain true. “The vaccine technology is different with these mRNA vaccines, but even so, the goal of these vaccines is to trigger an antibody and T-cell response, that’s our adaptive immune response. Our immune system functions in the same way no matter what vaccine technology is used,” Madison says.
Their conclusions are based on more than 30 years of research on vaccines like those for hepatitis A and B, the flu, typhoid, and pneumonia, among others.
What they’ve found? Stress, anxiety, depression, and other mental wellbeing factors can negatively affect three critical areas of immunization:
- How your body reacts in terms of side effects.
- The time it takes to develop protective immunity after the vaccination.
- The length of time that you remain protected from the vaccine.
“Some studies have found that people who are chronically stressed or depressed, don’t have clinically protected immunity for as long,” says Madison. “Essentially it becomes eroded over time.”
One study cited in the paper, for example, compared adults who were full-time caregivers (a time-consuming and stressful duty) to peers of the same age who were not caregivers. Both groups received a pneumococcal pneumonia vaccine, but the caregiver group experienced a decline in their antibody levels more quickly than the non-caregiver group. “It would suggest that it would be important to try to engage in stress management activities and seek mental health care if needed, even after receiving the vaccine in order to try and manage stress and mitigate its impact on our immune system,” says Madison.
Another study found that patients receiving a flu shot were more likely to have more amplified and prolonged inflammation if they had even mild depressive symptoms. A 2017 study found the same to be true for adults with anxiety as well.
And as we age, these effects become amplified. “I think it’s very widely recognized in general that age can weaken our immune responses to vaccination and so particularly these effects that I’m talking about, of stress and depression, are particularly salient for older adults,” says Madison.
What You Can Do Before Getting Your COVID-19 Vaccine
“My lab was seeing a lot of research coming out, for instance, from just how the rates of depression and anxiety are right now and weight gain and sedentary behavior — all of these risk factors for a poor vaccine response are really heightened right now,” says Madison.
Whether your appointment to get vaccinated is just around the corner or months away, there are adjustments you can make right now that could make a difference to how you respond to the vaccine. Even modest adjustments can make a difference, says Madison. She also stresses that you should get the vaccine as soon as you can and not defer to try and get all of your mental ducks in a row.
Here’s what you should be prioritizing leading up to your COVID-19 vaccine appointment.
It should come as no surprise that sleep deprivation can interfere with your immune system. After all, rest is universally prescribed for just about any illness. A recent study published in the International Journal of Behavioral Medicine found that people who slept less had a lower antibody response to the flu shot.
Make sure you’re not cutting corners on your sleep in the nights leading up to your appointment. “[Sleep] is truly a matter of health and a behavior we must take seriously, especially in the middle of a pandemic,” Sarah Pressman said in a press release. Pressman, a professor of psychological science at the University of California Irvine, co-authored the study.
Get in a run or other workout before your vaccination. “Vigorous exercise in the hours leading up to the vaccine can not only help to reduce the side effect profile, but could also — there’s some mixed evidence on this — potentially impact our antibody responses to the vaccine,” she says.
Similarly, staying active in the weeks after getting the vaccine can also bolster the immune response. Studies have shown that women who kept up a vigorous walking regimen for two weeks post-vaccination had a greater immune response than their non-active peers.
A study published in the journal Psychosomatic Medicine found that people who were in a meditation program showed stronger antibody levels after a flu vaccine than those who did not meditate. Other research has found that people who are more optimistic tend to have better immune responses to vaccines than those with a negative mood. Starting a meditation or visualization practice could help boost your mood and relax you at the same time.
Talk to someone
If you have some time before you’ll be able to get the COVID-19 vaccine, you might find it helpful to talk with a therapist or other mental health professional. “If you are struggling with depression or anxiety, now is the time to seek the help of a mental health care professional,” says Madison. She adds that cognitive behavioral intervention and mindfulness can help to bolster the immune response to vaccines.
More research still needs to be done in refining these recommendations, says Madison. Researchers can’t say for certain the “timing or dose” for these interventions. Even though they’ve seen a correlation with exercise improving immune response, they couldn’t say, for example, that you should go for a run at a certain intensity within a certain time frame prior to getting vaccinated. And of course, the research needs to be replicated with the new COVID-19 vaccines.
In the meantime, get some rest. Go for a run. Do whatever self-care routine gets you through the day. Though we don’t know how far away it is, we do know there is a light at the end of this tunnel. The pandemic won’t last forever.