3 Things You Missed

Big conversations this week ➡️ and bigger ones ahead

This past week, we tackled some of the most complicated—and misunderstood—parts of living with long COVID. If you missed it, you’ll want to catch up.

What’s coming next may matter even more.

Here’s what we covered, and what’s to come.

1. The truth about anti-depressants

I had an important discussion on Substack Live with psychiatrist Dr Sumaiya Mushtaq. Her newsletter, The Middle Path, shares ways to maintain our mental health in a world that feels messy. We discussed grief during illness: what is typical and what is worrisome.

She told me there is no such thing as “normal.” While grief does follow some common patterns, each of our experiences is unique, impacted by our lives and mental health pre-COVID.

Instead of thinking about what is normal or abnormal, Dr Mushtaq suggests we notice the ways our mental health affects our daily life. Sometimes feelings of sadness and anxiety that began as a response to our illness become a problem themselves.

The changes can be subtle. Feedback from our care partners and loved ones may help—but that requires vulnerability and trust.

I frequently see people in the long COVID space hesitate to try medication for depression and anxiety, so I asked Dr Mushtaq to explain the real risks of antidepressants like SSRIs and anxiolytics like ativan. Her bottom line: psychiatric meds may hold some risks, but there are also profound risks of leaving conditions like depression and anxiety untreated.

I agreed with her point that the fears we have about medications—and even therapy—are likely over-estimated. The truth is we don’t have to strong-arm our way through depression; it’s reasonable and responsible to seek help. That help may include medications, used judiciously.

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Read more about the science and risks of untreated mental health conditions here:

Why Long COVID Recovery Plateaus — and What’s Still Within Your Control

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Unfortunately, the Live video, which was recorded by Substack and edited by its AI tool, is a digital mess.

As soon as the issue is fixed, I’ll share the entire conversation.

2. Medication Management Workshop

I hosted a Zoom call with a small group of LCMD premium subscribers this weekend. We discussed ways to get control of our medications.

I’ll share more details in a coming post, but the key point is this: before I start any new treatment, I need to know what it’s treating and how to tell it’s working.

For most medical conditions, these questions are easy to answer. But without sufficient research and attention given to long COVID, the same questions can feel impossible for us—or our doctors—to answer.

But it’s not impossible.

Before starting any treatment, I recommend speaking with your doctor and learning:

1. Indication: What is this drug meant to treat? Do I have a problem this could help?

2. What’s the end-point? This is an especially important question to answer when we’re medication-sensitive and are titrating drugs. We may see benefits at lower-than-typical doses. When prescribing medications, I establish the criteria: Take until you reach X dose, X result, or X problematic side effect.

3. How do we measure results? Sometimes we follow lab values, sometimes we follow symptom progression. Both are imperfect markers, and especially for labs, may not even be available.

The best part of the workshop for me was getting to know subscribers like you, who are facing the overwhelm of long COVID with the same tenacity. You’re not asking for the moon. You’re looking for clarity, and you certainly deserve it.

3. What’s Coming

Here’s what you can expect in the coming weeks:

1. Substack Live with Dysautonomia Dietitian, another medical professional with long COVID. We’ll talk about the role of nutrition in chronic disease. Mark your calendars for Saturday February 28 at 9am PST/12pm EST.

2. An in-depth explanation of stellate ganglion blocks (SGB). This procedure is one of four interventions the NIH is studying for long COVID, and it’s performed commonly by anesthesiologists like me. I interviewed two SGB experts—including one of the scientists designing the SGB study—to help explain the indications, risks, and how to find a provider.

3. A break: My Ramadan goal is to fast a few days (my health hasn’t allowed it in years), focus on family, and restrict my time online. I’ll continue to work on research, videos, and newsletters for you, but expect fewer Notes and limited messaging.

4. Coaching and Support Calls: I’m continuing to work on the details, but after the robust Q&A session during our Medication Workshop, I’m convinced that supporting you with one-on-one calls is a needed addition to LCMD.

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