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When Annelise Madison, a PhD candidate in clinical psychology at the Ohio State University, was reading about the mental health implications of lockdowns—stress, depression, loneliness, poor health behaviors—as the novel coronavirus was spreading in the early spring of 2020, she began to connect some dots. At the time, a vaccine was far out of sight, but it was easy to see the toll these mental health symptoms could take in the future.
Madison works in the Stress and Health Lab at the Institute for Behavioral Medicine Research at OSU. Her advisor, Janice Kiecolt-Glaser, an expert in psychoneuroimmunology, has been studying how mental health impacts the immune system for more than 30 years.
When the first COVID-19 vaccines became available last year, the lab members submitted a multi-study review outlining what is known about mental health and well-being and how that affects the body’s response to vaccines.
You might have experienced this mind-body phenomena personally: Moments where stress has weakened your immune system, like getting a cold after pulling an all-nighter, or succumbing to the flu after completing a hard race and intense training season.
There’s no denying the stress caused by the pandemic has been unmatched.
Although acute stress reactions are meant to be protective, when they are felt for long periods it can lead to long-term problems like chronic fatigue, depression, and immune disorders. It can also affect the way your body reacts to vaccines.
The Mind-Body Response to Vaccines
Looking at more than 30 years of research on vaccines like those for hepatitis A and B, the flu, typhoid, and pneumonia, among others, the OSU lab found that stress, anxiety, depression, and other mental wellbeing factors can negatively affect three critical areas of immunization:
- How your body reacts in terms of side effects.
- The time it takes to develop protective immunity after the vaccination.
- The length of time that you remain protected from the vaccine.
“Some studies have found that people who are chronically stressed or depressed, don’t have clinically protected immunity for as long,” says Madison. “Essentially it becomes eroded over time.”
One study cited in the paper, for example, compared adults who were full-time caregivers (a time-consuming and stressful duty) to peers of the same age who were not caregivers. Both groups received a pneumococcal pneumonia vaccine, but the caregiver group experienced a decline in their antibody levels more quickly than the non-caregiver group. “It would suggest that it would be important to try to engage in stress management activities and seek mental health care if needed, even after receiving the vaccine in order to try and manage stress and mitigate its impact on our immune system,” says Madison.
Another study found that patients receiving a flu shot were more likely to have more amplified and prolonged inflammation if they had even mild depressive symptoms. A 2017 study found the same to be true for adults with anxiety as well.
And as we age, these effects become amplified. “I think it’s very widely recognized in general that age can weaken our immune responses to vaccination and so particularly these effects that I’m talking about, of stress and depression, are particularly salient for older adults,” says Madison.
What You Can Do Before Getting Your COVID-19 Vaccine or Booster
COVID-19 vaccines are not 100 percent effective in preventing illness, but are more effective in preventing serious illness.
Madison hopes to educate people to get the most out of their vaccine for as long as possible in between doses and subsequent boosters.
“My lab was seeing a lot of research coming out, for instance, from just how the rates of depression and anxiety are right now and weight gain and sedentary behavior—all of these risk factors for a poor vaccine response are really heightened right now,” says Madison.
Even modest adjustments in lifestyle can make a difference for your immune response, says Madison. Here’s what you should be prioritizing leading up to your COVID-19 vaccine or booster appointment.
It should come as no surprise that sleep deprivation can interfere with your immune system. After all, rest is universally prescribed for just about any illness. A recent study published in the International Journal of Behavioral Medicine found that people who slept less had a lower antibody response to the flu shot.
Make sure you’re not cutting corners on your sleep in the nights leading up to your appointment. “[Sleep] is truly a matter of health and a behavior we must take seriously, especially in the middle of a pandemic,” Sarah Pressman said in a press release. Pressman, a professor of psychological science at the University of California Irvine, co-authored the study.
Exercise before or after.
Whether you run in the morning, afternoon, or evening, emerging research finds you can’t go wrong with squeezing in some exercise the day of your vaccination.
Feel up to running before your shot? “Vigorous exercise in the hours leading up to the vaccine can not only help to reduce the side effect profile, but could also—there’s some mixed evidence on this—potentially impact our antibody responses to the vaccine,” says Madison.
Another study that has gotten a lot of attention this month found more specifically that 90 minutes of light to moderate exercise after getting a shot increases antibody response. This was true for multiple vaccines tested, including COVID-19 vaccines. This study did not find that exercise made any difference in side effects from the vaccines.
Though that study was small (20 total participants for the flu vaccine portion, 36 for the COVID vaccine group, and another clinical group of mice), it is still encouraging as one of the first to look at the COVID vaccine specifically.
Beyond just the day of vaccination, staying active long-term seems to help the body bolster its response to vaccines. A meta-analysis published in the journal Sports Medicine found that regular physical activity reduced the risk of infection from community-acquired illnesses and increased antibody concentration after vaccination.
Similarly, staying active in the weeks after getting the vaccine can also bolster the immune response. Studies have shown that women who kept up a vigorous walking regimen for two weeks post-vaccination had a greater immune response than their non-active peers.
A study published in the journal Psychosomatic Medicine found that people who were in a meditation program showed stronger antibody levels after a flu vaccine than those who did not meditate. Other research has found that people who are more optimistic tend to have better immune responses to vaccines than those with a negative mood. Starting a meditation or visualization practice could help boost your mood and relax you at the same time.
Get therapy if you need it.
In the long term, you might find it helpful to talk with a therapist or other mental health professional. “If you are struggling with depression or anxiety, now is the time to seek the help of a mental health care professional,” says Madison. She adds that cognitive behavioral intervention and mindfulness can help to bolster the immune response to vaccines.
More research still needs to be done in refining these recommendations, says Madison. Researchers can’t say for certain the “timing or dose” for these interventions. More research needs to be done to include the COVID-19 vaccines, specifically.
In the meantime, get some rest. Go for a run. Do whatever self-care routine gets you through the day. Do your best to stay safe and healthy.
Editor’s note: This article has been updated with new information. We will continue to update this story as we receive new or expanded advice from experts. Please visit the CDC or World Health Organization websites for more information.