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These coronavirus survivors lost their sense of smell. Then depression set in

Steve Clark lost his sense of smell in late March due to a suspected coronavirus infection. Five months later he was taken to the hospital for a depressive breakdown — a direct consequence, Clark believes, of his inability to smell. “I just couldn’t get my head around it. I started to go down a bit of a dark alleyway,” the 63-year-old U.K. resident says. “My wife, in the end, had to get an ambulance for me.”

Without his sense of smell, Clark has had little ability to taste. He says he dropped over 20 pounds in the first four weeks from lack of appetite. Months after recovering from the virus, he can still only taste a few flavors, like sweet and smoky. Savory flavors elude him, and regaining the weight has been a slow struggle.

Worse, perhaps, is that Clark says living without his sense of smell has made him feel cut off from the world around him, which has taken a toll on his mental health. He describes feeling trapped in a vacuum, or stuck behind an acrylic window. “I could see everything that was going on, but I felt detached from it, as if I couldn’t quite get at it,” Clark says. “I didn’t feel like I was part of the same universe anymore … and I felt isolated. Very isolated at times.”

Loss of smell, a.k.a. anosmia, is one of the telltale signs of COVID-19. Much of what’s known about the condition and its mental health consequences, though, comes from pre-coronavirus research on patients whose anosmia was brought about by other ailments, from head trauma to complications from the common cold.

A “fast recovering” group of patients who lost their sense of smell due to COVID-19 has gotten it back within days or weeks. A second group, to which Clark belongs, has struggled with little to no sense of smell; a sense of smell that fluctuates widely; or parosmia, a distorted sense of smell that can create unusual smell-based hallucinations, even months after recovering from the virus. It’s unclear when, if ever, these longer-term anosmia sufferers will fully recover.

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Chrissi Kelly, founder of Abscent, an organization that provides support for anosmia sufferers, said the pandemic has drawn thousands of new members to the organization’s Facebook group, many in evident distress over their smell loss. “I have seen lots of people … who I would say are just on the edge. I mean really, really serious, to the point where I have to say, ‘You need to get help. You need to call a doctor, you need to tell someone,’” she says.

Science backs up Kelly’s observation. Researchers have linked smell loss with depression for decades. A recent study found that, of all the COVID-19 symptoms, anosmia was the one most closely associated with depressed mood and anxiety.

Some of that anxiety seems to stem from an inability to smell “bad” odors, which can alert us to environmental hazards, spoiled food, or to things that need cleaning. “My constant worry is not knowing if there’s a danger,” says Nicola Brierly-Fletcher, a 36-year-old U.K. resident who lost her sense of smell in June due to COVID-19. “I wouldn’t be able to smell a gas leak or smoke if my house was on fire. I’m constantly paranoid about my own body odor. I can’t tell if my toddler needs changing when he’s done a poop, or if the cat litter needs changing.”

Aside from her anosmia, Brierly-Fletcher has mostly recovered from the virus, although she does still get out of breath easily from walking short distances. She’s not sure if that’s a lingering effect of COVID-19, or if it’s because she’s nearly nine months pregnant with her second child. “It makes me sad to know that I won’t be able to smell her newborn baby smell,” she says.

Many also describe an initial wave of anxiety as they first realized they could no longer smell. “It almost felt like I was suffocating,” says Illinois resident Nain, who did not wish to use her last name due to a fear of stigma around mental illness. “I remember distinctly putting my face into a jar of salsa and not being able to smell it, and then all of a sudden it was this panic feeling, like a claustrophobic feeling of, oh my god, what is happening to me? What is this?”

As for the depression associated with anosmia, that can be partly explained by a straightforward psychological response to loss, according to Ilona Croy, a professor of psychology at the University of Dresden, where she researches the link between olfaction and wellbeing. Smell provides many benefits, such as allowing us to enjoy our food, feel confident about our hygiene, and connect with loved ones. Its sudden disappearance can be jarring and traumatic, and can trigger a kind of grief.

“All of those functions, when you lose them, you suddenly become aware that there are a lot of experiences which you probably did not even think you had enjoyed. And now that you don’t have them anymore, you feel the loss and you suffer from that,” Croy says.

There may be a neural explanation for anosmia-linked depression, in addition to the psychological one, according to Croy. Smells travel to the brain along the olfactory channel, which is intertwined with brain circuits responsible for generating emotion. As the channel starts carrying less information from the nose, patients show decreased activity along those circuits overall, which could contribute to a lack of motivation and a reduced ability to feel pleasure — key features of depression.

“If you want to generate an emotion, you have to have a certain number of synapses of nerve fibers which generate the signal,” says Croy. “Some of those nerve fibers relate to olfaction, and if there are just fewer of those, then it’s harder to generate emotions in general.”

Researchers have found that the link between depression and smell loss moves in both directions. People who lose their sense of smell are more vulnerable to depression, and depressed people commonly have an impaired sense of smell. In the latter case, as mood improves, ability to smell typically does as well, bolstering the theory that emotional signals and scent signals are tied together, Croy says.

That was the case for Nain, whose mental health improved along with her anosmia. When she lost her sense of smell in late March, Nain experienced severe depression. “I cried multiple times a day. I cried to my sister, I cried to my dad,” she says. At one point, she called a mental health crisis hotline to talk about her depression and her smell loss, which hadn’t officially been declared a COVID-19 symptom yet. “They didn’t really understand it,” she says.

Roughly six months after recovering from the virus, Nain’s sense of smell is nearly back to normal, although she still has days when it seems somewhat muted. She says she’s feeling much better emotionally as well.

Through Abscent, Kelly teaches anosmia sufferers how to “smell train,” which involves taking attentive whiffs from jars of essential oils, like lemon and lavender, and focusing on what scents the nose is able to detect. The practice has been shown to boost recovery. Since the pandemic began, the organization’s Facebook group has swelled from a few hundred members to a community of over 8,000, where people share thoughts, fears, and tips on living with smell loss. It helps people cope with anosmia, Kelly says, which may be the best they can do for now.

“I think people are so anxious and so angry and so unhappy. Like, ‘No, no, no, I only want my sense of smell back,’” she says. “There is a period of acceptance and a kind of philosophical adaptation to your new state, to accepting the new normal. And people have to be helped to feel that that’s okay too.”