Long Covid or chronic depression? 5 years of symptoms and still no clear answer

Hi everyone,

I’ve been stuck for years between two hypotheses: chronic “classic” depression vs a post-infectious syndrome like Long Covid / ME-CFS. I’d really appreciate your thoughts.

• Male, 30.
• Symptom onset: September 2020. No documented Covid infection at that exact time (no clear acute respiratory illness right before).
• In 2022, I had positive Covid serology (very high anti-spike antibodies), so I probably had Covid at some point, but it’s impossible to date it precisely.

At the beginning (2020–2021), my symptoms were mainly:

• very strong anxiety, inner agitation, restlessness,
• insomnia, tremors, panic-like feelings,
• significant digestive issues.

Between 2020 and now, I’ve tried around 6 antidepressants (mainly SSRIs/SNRIs + 1 other type). None of them were taken longer than 2 months, except one that I stayed on for 6 months. I never had full remission: either side effects, or partial but incomplete improvement.

Over time, the picture changed:

• much less acute anxiety,
• but chronic fatigue, lightheaded / brain fog,
• very low motivation, reduced ability to feel pleasure,
• concentration problems, feeling like I’m on “autopilot”,
• sometimes feeling worse after bigger physical efforts (mild post-exertional crashes).

Some medical findings:

• Thyroid in the normal lab range (TSH on the higher side of normal),
• low-grade inflammation (CRP sometimes a bit elevated but not massively),
• markers suggesting viral reactivation (EBV),
• some immune abnormalities (low CD8) and gut dysbiosis.

Doctors are divided: some lean toward major depressive disorder, others suspect a possible Long Covid / ME-CFS-type syndrome with secondary depression.

My question to you all:
For those who have been through something similar, does this sound more like a chronic depression that gradually changed its expression, or more like a post-infectious syndrome (Long Covid / ME-CFS) with psychiatric symptoms on top?