February 20, 2019
I call my mom once or twice a week to check in. When I called her yesterday, she took a second or two longer to speak than usual. Then, when she did speak, she sounded pretty awful.
“Welcome,” she whispered,
“To the house,”
It seemed like it was hard for her to get this little six-word sentence out of her mouth.
“You OK?” I asked, getting worried.
I heard her take another shallow breath.
“I’ve got… the flu.”
She’d received the vaccination last fall like lots of Americans this year, but she got the bug anyhow. She explained to me that she had started taking anti-influenza medications, and she was already feeling better than she did the day before. Still, influenza in an older person—and she’d kill me if she knew I was calling her old—is a big deal.
This got me thinking about the effects of this year’s historic flu season on the psychological well-being of kids. After all, I’m her kid and I was scared, and I’m supposedly all grown-up. Combine my concerns with the 24-hour news cycle that seems always to work in some commentary about the ravages of this year’s flu, and it’s no wonder that lots of kids are getting a little jumpy around this subject.
With this in mind, I’d like to spend a few minutes here discussing the possible psychological ramifications of influenza as the virus spreads with unusual virulence throughout our nation.
Let’s start with some general facts. Some kids will ask their parents the very questions that I’m listing below, and many of these kids will do much better if they hear a calm and informed explanation from their parents. This is especially the case for kids who get anxious during times of uncertainty. Remember that as a parent, you’ll always be better than Google at quelling your child’s anxieties.
What does the flu come from?
The “flu” is the colloquial term that we use for the yearly wanderings of the impressively resilient influenza virus. This germ should not be confused with Haemophilous Influenza, which is a bacterial infection more common in younger children. You can read about Haemophilous Influenza at the CDC website here.
The influenza virus is an intrepid little pathogen that saunters around the earth with predictable regularity, changing and mutating to make it less vulnerable to our immune systems in something close to real time. In other words, every influenza cycle is different because the virus is massively adaptable as well as punctually seasonal. When it is winter in the southern hemisphere, the influenza virus makes its home down under. When things get cold for us up here in the States, the virus hops a plane or a boat to our shores. This has been going on for about as long as history has existed. The constantly changing nature of the influenza virus means that there is a new vaccine every year, and that each new vaccine is based on the best guess as to how the virus will present itself to our immune systems once its new season arrives.
What are the symptoms of the flu?
I’m unlikely to tell you anything here that you don’t already know. You got your fevers, and your coughs, and your headaches, and your gastro-intestinal upset. This is all paired with an impressive array of aches and pains. You can read all about the symptoms here. Still, the best description I’ve heard comes from my father, a now retired intensive care doctor.
“You’ll feel,” he told me, “like you’ve been hit by a truck.” I had the flu in the absence of the vaccine exactly once, and I can tell you that his description is pretty accurate. In truth, I’ve never actually been hit by a truck (luckily), but I might choose that particular trauma over unfettered flu symptoms. That’s how bad I felt.
Should you get a vaccine?
YES! And there’s still time. I won’t take up too much space to drive home this point, but please know that in the absence of allergies that would prevent being vaccinated, even during years when the vaccine offers worse coverage than we’d like, the course of the flu is often less severe if the vaccination is received in time. You can read about the vaccine here.
Why in the world is a psychiatrist writing an article about the flu?
Great question! I’d start by noting that a psychiatrist worries about the flu for the same reasons that a pediatrician worries about depression. Feeling lousy from the flu makes the other things that make you feel lousy feel a whole lot lousier. There is evidence that children and adolescents with the flu will experience worsening mood and anxiety during the infection, and this is especially the case for young people with pre-existing psychiatric syndromes.Because psychiatric distress is associated with inflammation, and because the flu puts your body in a highly inflammatory state, it is likely that this inflammatory state worsens the body’s psyche. That’s probably why these psychiatric symptoms improve with Tylenol or Ibuprofen or other methods by which the inflammatory system can be cooled.
By the same token, pre-existing depression, anxiety and other psychiatric syndromes can make it very difficult to recover readily from a bout of the flu. Some of this has to do with the mechanics of self-care. If you’re depressed, you’re less likely to care for yourself well, and this gets even worse when the flu is folded into the mix. Additionally, high stress states like depression can dampen the immune response to other illnesses, including influenza. That’s why we are more likely to become ill, both medically and psychiatrically, when we are under the influence of highly stressful circumstances.
Moreover, the flu, like all significant illnesses, promotes developmental regression. This means that children will feel and act younger than their actual age. Little kids with the flu will want to snuggle more or might have a much lower frustration or pain tolerance. Older kids will have more tantrums and can be more irritable or nihilistic. There is even some concern that the flu can awaken previously mild psychiatric vulnerabilities. This is in part related to the fatigue that the flu engenders, and in part related to the inflammatory response that the flu and other psychiatric syndromes have in common. There’s no real separation between mind and body. After all, the neck connects the head to the rest of the body.
If your feelings suffer, you feel sick. If you feel sick, your feelings suffer. That’s the nature of being human.
At the end of the day, the biggest psychiatric issue that accompanies the flu is the fact that many of the symptoms of the flu mimic many of the symptoms of psychiatric disorders. Loss of interest in previously enjoyable activities, decreased energy, poor concentration, excessive worry…. These are all symptoms of the flu and also of psychiatric states like depression or anxiety. As with much of medicine, the extreme cases are easy to tease apart. Fever, aches, and barfing are mostly related to an infectious disease until proven otherwise and then perhaps made worse by a psychiatric syndrome. However, if the fatigue and aches linger after the flu is clear, and if the pediatrician is at a loss to explain the residual symptoms, the epidemiology favors at least entertaining a psychiatric diagnosis.
What About Treatment?
Besides what we call supportive care—getting ample rest, staying hydrated, keeping the fever under control—there are excellent medications that treat the flu. There have been sporadic reports of anti-flu medicines causing psychiatric symptoms. Generally speaking, these instances are extremely rare and one should follow the recommendations of the prescribing physician if he or she deems anti-flu medications appropriate.
I’ve also been asked whether anti-flu medicines interact with psychiatric medicines. Before we even address that issue, we should note that the symptoms of the flu itself can affect the efficacy of psychiatric medicines. After all, your medicines don’t stand much of chance when you barf them back up. If vomiting is a frequent symptom, don’t be surprised if some psychiatric symptoms worsen purely as a result of poor absorption of the medications meant to treat these conditions. In terms of drug interactions, there is little evidence that anti-flu medications meaningfully interfere with the metabolism or efficacy of psychiatric medicines. Your best bet is to take what you’ve been prescribed, but to make sure that all the doctors who treat you know what you’re taking.
The flu, for the vast majority of us, passes. It makes for a particularly awful couple of weeks but nothing more. Still, don’t hesitate to get treatment. Spring will get here, but this is a tough season, and we’re only about halfway through it.