Overview

Respiratory syncytial virus (RSV) (pronounced sin-SISH-ul) is an underlying cause of different acute lower respiratory tract infections such as pneumonia, chronic obstructive pulmonary disease (COPD) and bronchitis. Although more often suffered by infants, research has shown that RSV has been responsible for the hospitalisation of 158,000 adults in European countries alone.¹ Among adults, those over the age of 65 are the most at risk of RSV.¹ Despite the usual symptoms being compared to that of a cold, it can be seen how living with RSV can be a stressful time for many adults.² This can be because someone is living with RSV themselves, or being affected by a loved one suffering from RSV too. Most cases are not severe, but as growing research is highlighting, mental health can begin to take a toll because of RSV. So what can we do to prevent RSV infection, and what is the link between RSV and depression? 

What are the causes of RSV?

RSV is most prevalent during late autumn into early winter. The virus is spread by droplets that come from coughing or sneezing, lasting over a day on the skin and non-porous surfaces like door handles, tables or cutlery.^3,4 This makes it easy to spread around quickly. Other factors contributing to the risk of RSV infection include:^3,5,6,7 

• Existing chronic cardiopulmonary diseases, such as asthma, COPD and cardiac disease 
• Malnutrition - a lack of vitamin D has been linked to weaker immune systems 
• Smoking 
• Old age 
• Weakened immune systems 
• Poor air quality, such as crowded living conditions, air pollution or living spaces with mould 

It is also important to note that COVID-19 also has an impact on the risk of contracting RSV. Due to the lockdown guidelines in different countries, researchers have found that many people have dysregulated or weakened immune systems because of the lack of exposure to viruses like influenza (common flu) or cold.⁶ A weakened immune system means more adults have a likelihood of being infected with RSV with some still trying to adjust to life out of lockdown. 

What are the symptoms of RSV?

For adults especially, symptoms may not be visible until up to 6 days after initial infection. Typically these include:

• Runny nose 
• Nasal congestion 
• Fever 
• Wheezing 
• Sneezing 
• Sore throat 
• Loss of appetite 

How can RSV be treated and managed?

Generally, the focus of RSV treatment is to relieve pain from symptoms. In mild cases, painkillers can be used. It is also recommended to make sure that water is regularly taken to avoid dehydration. However, for more severe cases the antiviral drug ribavirin is given. Ribavirin prevents RSV from copying itself and spreading in the lower respiratory tract.⁷ Importantly, it should be noted that there is potential of ribavirin becoming toxic to patients so this treatment option is a last resort. 

In some countries, it is possible to get an RSV vaccine. However, this appears to be available typically for infants up to the age of 2 years old, or the elderly from 60 and above. 

How is RSV diagnosed in adults?

Diagnosing RSV in adults has proven to be more difficult because the symptoms are typically dismissed as a cold since they are very similar. Furthermore, adults do not present symptoms for almost a week, or may not show any symptoms at all.⁶ Adding to this, rapid antigen tests (like the home COVID-19 tests) taken to identify RSV are frequently unable to detect RSV.⁴ 

For some people, when RSV is detected, the infection can become severe which leads to hospitalisation or long-term cardiopulmonary effects. Understandably, these outcomes and the risk factors of RSV may themselves be risk factors of depression. 

How could RSV be a risk factor for depression?

What is depression and its symptoms?

Depression is a mental health condition that can last from 2 weeks up to months, or more. It is not just a period of a low mood, but a condition that begins to interfere with daily life. Over time, it can become incredibly disabling for those living with depression. Symptoms of depression can include: 

• Continuous stress, anxiousness or sadness
• Irritability 
• Weight fluctuations 
• Changes in appetite 
• Isolation 
• Loss of interest in activities that were once enjoyed
• Increased alcohol intake or substance use 
• Sleep disturbances
• Fatigue and loss of energy 
• Lower libido

There are also different types of depression that people may be living with including:

• Major depressive disorder - Shorter periods of depression are experienced, but the symptoms are more severe 
• Persistent depressive disorder - Depression may last up to many years for longer periods, but the symptoms are not so severe 
• Seasonal affective disorder (SAD) - Symptoms of depression typically begin to appear in early winter, but then reduce or completely go away from the spring or summer

What are the biomedical risk factors of depression linked to RSV?

When the body is trying to fight back against RSV, inflammation increases throughout the immune system as more cytokines are released (the small proteins which help increase an immune defence response to viruses).⁸ However, researchers have found that increased inflammation can cause an imbalance of serotonin in the brain. Serotonin imbalance is closely linked to depression as this neurochemical is thought to be the ‘happy hormone’.⁸ Once this is out of equilibrium, there is an increased risk of symptoms of depression.

What are the environmental risk factors of depression linked to RSV?

Aside from biological factors, there are also risk factors that arise in our social environments closely linked to RSV

The winter season 

Remember that SAD typically begins at the end of autumn into the early winter. At this time also, the rate of RSV infection is at its highest within populations. The link between RSV and depression here is that people are likely to be vitamin D deficient at this time due to the lack of sunlight in the winter months (aside from a lack of vitamin D intake from diets). Researchers have found that a lack of vitamin D deficiency can make people more susceptible to RSV, and create problems with making and releasing serotonin in the brain.^5,9.

Stress from hospitalisation

For adults, hospitalisation because of RSV can prove a very stressful and anxious time for many. This can even be more stressful for an adult to watch a family member be hospitalised because of RSV, and not be able to do much to help relieve them of their pain. Situations like this can make an adult feel hopeless, which can increase the risk of depression developing.² 

Loss of productivity and financial status

Dealing with illness can mean that adults may take leave from work. This loss of working hours could mean a decrease in income for a certain period. For many, financial position can be a sensitive topic and a source of worry. Researchers have also found that socioeconomic status, income and financial stress can be risk factors for depression.¹⁰ 

What can be done to maintain good mental and respiratory health?

After identifying the links between RSV and depression, it is important to think about the ways we can prevent and manage our mental health and respiratory health in different circumstances.

Reflecting on lifestyle choices

Understandably, lifestyle choices such as our diet, physical activity levels or sleep patterns may be limited by our socioeconomic status which includes the types of jobs and income someone may have. However, it is important to do our best to make small lifestyle changes in whatever capacity we can for better mental and respiratory health. This may look like: 

• Quitting smoking
• Going on walks
• Dietary changes to include more water, vegetables and the right vitamins

Good hygiene

It is important to keep up good hygiene habits to lower the risk of infection. This is vital, especially in the winter months when people are most vulnerable to different viruses. This includes constantly remembering to wash hands after using the bathroom, and keeping up our personal hygiene. For people living with depression, regularly practising good personal hygiene may be more difficult with feelings of worthlessness involved so different interventions must be used to support and encourage adults living with depression.¹¹

Medication

In some cases, a doctor may prescribe medication to treat depression.¹² Caution must be taken if medication, like antidepressants, is needed to be taken alongside painkillers to relieve RSV symptoms as these medications can interact. 

Psychotherapies 

If infected with RSV, it is very easy to self-isolate from friends and family as severe cases can be very stressful on the mind and body. Isolation and self-withdrawal are also symptoms of depression. However, researchers have found that therapies such as mindfulness cognitive behavioural therapy (MCBT), and marital or family therapies can be used to aid adults in discussing the troubles and feelings they may be going through due to the symptoms of RSV infection.¹² 

Religion and spirituality 

The elements of hope, optimism and community within religious beliefs and practices have been shown to help reduce suicidal ideation and also influence lifestyle choices for the better.¹³ However, it is important to recognise that there has been a history of religion being used to minimise the impact of mental health issues on daily life, so it is still recommended to look at other options.

Summary

Respiratory syncytial virus (RSV) is a contributing factor to various types of lower respiratory tract infections, including pneumonia and bronchitis. The symptoms are similar to those of a cold, but for adults over the age of 60, the infection can become more severe. For most, however, there are minimal to no long-term effects on the body. 

Typically at its peak in the winter months, it also has the potential to impact the mental health of many adults and leave people at risk of depression due to the changes to serotonin levels in the brain, as well as social and environmental factors that underlie both RSV and depression. 

RSV and depression may be difficult to diagnose and manage, but it does not have to be tackled alone. If you are experiencing symptoms of RSV or depression, reach out to your general practitioner or family doctor for further recommendations for treatment.