Post-Acute COVID-19 Care: Case 3

eConsult Clinical Question

A 54-year-old woman had a COVID infection after being fully vaccinated. Patient having persistent symptoms of difficulty with focus and concentration. Her Montreal Cognitive Assessment (MoCA) today in clinic was 26/30 with difficulty with memory, and delayed recall as well as concentration. She tried 10 mg of Adderall that she got from her sister-in-law who also had chronic COVID symptoms with improvement. Is there proven utility with stimulants for post COVID and/or use of modafinil and excessive fatigue?

eConsult Response

This is all so new that there is not yet evidence to support this practice. Stimulants can help with symptoms of focus and concentration in some other non-attention deficit hyperactivity disorder (ADHD) conditions, such as traumatic brain injury patients, but their efficacy in general is limited to an ADHD population. While many patients who use diverted medications "feel better" on stimulants, this rarely is evidenced by improved functioning or improved performance on objective measures of focus and concentration. Modafinil is occasionally used for antidepressant augmentation and is approved for increasing alertness in patients with narcolepsy.

I don't see a Patient Health Questionnaire (PHQ)-9 score for her but her last generalized anxiety disorder (GAD)-7 score was borderline, it is also possible her anxiety and depression are not well controlled post-COVID, and she may need an antidepressant adjustment, or augmentation with Wellbutrin.

These real-life examples have some limitations. Given the evolving recommendations and guidance on COVID-19 care, these cases should not be considered complete or definitive and may not reflect the most up-to-date guidance.