Ivan Agerton pulled his wife, Emily, into the bedroom closet, telling her not to bring her cell phone.
“I believe people are following me,” he said, his eyes shining with fear.
He described the paranoid delusions that haunted him: that people in cars entering his cul-de-sac in the Seattle suburb were spying on him, that a SWAT officer was crouching in a bush in his backyard.
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It was a drastic change for Agerton, 49, a former marine and risky documentary photographer, whose most recent adventure involved exploring the Red Sea for two months in a submarine. He was used to stress and said that neither he nor his family had previously experienced mental health problems.
But in mid-December, after a mild case of COVID-19, he was stricken with a kind of psychosis that turned life into a nightmare. He couldn’t sleep, worried that somehow he had done something wrong, suspected ordinary people for sinister reasons and ended up being hospitalized in a psychiatric ward twice.
“Like a light switch – it happened so fast – this intense paranoia hit me,” said Ivan Agerton in interviews for two months. “It was really, alone, the most terrifying thing I have ever experienced in my life.”
Agerton’s experience reflects a phenomenon that doctors are increasingly reporting: psychotic symptoms emerging weeks after coronavirus infection in some people with no previous mental illness.
Doctors say these symptoms may be a manifestation of COVID-19 side effects related to the brain. Along with more common problems such as brain fog, memory loss and neurological problems, “new onset” psychosis may result from an immune response, vascular problems or inflammation of the disease process, experts speculate. Sporadic cases have occurred with other viruses, and although these extreme symptoms are likely to affect only a small proportion of COVID survivors, cases have emerged worldwide.
Much about the condition remains mysterious. Some patients feel the need to harm others or themselves. Others, like Agerton, do not have violent impulses, but they become almost obsessively paranoid. Some need weeks of hospitalization with doctors experimenting with different medications, while others get better more quickly. Some patients relapse.
Agerton spent about a week in a psychiatric ward in December, missing Christmas with his wife and three children. By mid-January, he appeared to have recovered and his doctor planned to cut down on his antipsychotic medication. In February, however, “paranoia came back screaming,” said Agerton in an interview the day before he was hospitalized a second time.
“I have all these questions,” said Dr. Veronika Zantop, a psychiatrist who has treated Agerton since his first hospitalization and who confirmed that he had no previous mental health problems. Among them: “Is this temporary? Do you know, how long does the risk continue? “
The paranoid delusions most commonly accompany schizophrenia in late adolescence or dementia in older adults, but so far, post-COVID psychosis has mainly affected patients in their 30s, 40s and 50s.
Another notable difference: some post-COVID patients realized that something was wrong, while patients with typical psychosis often “are unaware of their symptoms,” said Zantop.
With Agerton, she said, “It’s almost like he has a divided self, where he was able to say, ‘My brain is telling me that the police are after me.’ And then he was also able to say, ‘I know this is not true on some level, but it seems like reality to me.’ “
After a December New York Times article on post-COVID psychosis, several people got in touch to say that they, or someone they knew, experienced it. Agerton said he would like to share his experience to help others by raising awareness about the disease.
Agerton tested positive for the coronavirus in late November, after returning from the Red Sea. As the expedition team followed strict precautions, he assumed he was infected while on his way home. With low fever, mild respiratory symptoms and loss of smell, he isolated himself in a room at home on Bainbridge Island, near Seattle, for 10 days, protecting Emily Agerton, 46, and his children, 5, 11 and 16 years old .
Then, on December 17, a common spam call on his cell phone triggered a cascade of paranoia linked to technology, surveillance and government officials.
“I started having these auditory hallucinations,” he said. He would jump to the window at night, imagining voices outside. Fearing that families looking at his neighborhood’s Christmas lights were spying on him, he would take the family’s Australian shepherd, Duke, and go out “to check on the people in the car,” he said. Then, he would convince himself that the police scanners were transmitting his dog walking and all the other movements he did.
“I couldn’t control myself,” he said, adding, “I was just thinking, ‘I’m losing my mind.'”
After almost two days of sleeping without keeping it to himself, he confided to his wife, who was stunned.
“Having a person who is great in a crisis going through a crisis was just total helplessness and fear for me,” she said.
He asked her to put the family’s phones in airplane mode and feared that the house was bugged. He was “very anxious” because of an ambulance siren, said Emily Agerton, who drove him to look for her. “Probably every 30 minutes, he needed to do the rounds outside and see what was out there.”
She took him shopping, thinking that “something as stupid as Costco would help make it just a normal day”, but said he feared that customers were plainclothes agents.
“It was real torture for him,” she said.
That night, she called a friend, a nurse with experience in mental health.
“You need to go to the emergency department right now,” the friend asked, adding, “lock all the guns,” “said Emily Agerton.
Although Ivan Agerton had no thoughts of suicide or murder, his wife added an extra locking mechanism to a safe containing a pistol.
“That he could hurt himself or me or the children didn’t even occur to me, but that is an entirely different element of fear and protection that is beginning to arise in you,” she said.
Emergency room doctors ruled out a brain tumor and sent him home with sleeping pills. But after he fell asleep, “the delusions started again when he told them good night the night before,” said his wife. “It was getting worse and worse. It was something new every 10 minutes. “
Emily Agerton, a health administrator and part-time student studying organizational leadership, desperately sought psychiatric help for him. Finally, her nurse friend found a place at the Swedish Medical Center in Seattle.
On the ferry to Seattle, Ivan Agerton imagined that a FedEx truck driver was hacking his cell phones. At the hospital, a wrong call to his room phone shook him.
“It was that snowball effect,” he recalled.
“When he came to us, he was very psychotic,” said Zantop, who focuses on the intersections between medical, neurological and psychiatric issues in the Swedish center. “He was having a hard time dealing with these constant thoughts that he was about to be caught by the police or thrown into prison.”
He asked his wife to inform two friends who were photographers, explaining their absence from the text group.
“Ivan is a very self-conscious and controlled chaos guy,” said one of them, Vincent Laforet, who contacted anyone who could help, including the company that leads the Red Sea expedition, OceanX. “When that kind of person comes to you through your wife, it’s almost like sending an SOS broadcast of ‘I’m losing control’.”
Vincent Pieribone, vice president of OceanX and professor of neuroscience at Yale, spoke with Ivan Agerton’s doctors. He said it was crucial for Agerton to recognize that he was in trouble and not be ashamed to seek help.
An MRI and other tests found no identifiable problems, said Zantop, who immersed himself in the search for COVID-related cases.
At first, Agerton cried and looked out at a parking structure “where I thought there were guys watching me,” he said. His photographer’s eyes were baffled by the hospital’s lighting, which he said was “out of a bad movie”.
At Christmas, he spoke to his family over the phone.
“It was very sad,” said his wife.
He worried about how his children would process his situation. He hoped that doctors will not blame the stress or danger of his work, which he loves.
“Part of me was thinking, ‘This is who I am and my career is over, my life is over,'” he said, in a choked voice.
Zantop said an antipsychotic medication, as well as information and guarantees, including that security guards were not after him, helped him “calm down”.
He also delved into books about Napoleon and the Lost Boys of Sudan, although, he said, “I had to reread paragraphs two, three, four times”.
Just before New Year’s Day, he returned home. Five days later, he estimated that he was 85% recovered, except for “small twinges”, like thinking that a neighbor’s air outlet was a submarine periscope.
Zantop found that Agerton was doing well. In mid-January, after his 50th birthday, he said he felt “100%”. But a month later, a headline about a police operation rekindled the symptoms. He felt less anxiety than before, he said, but “my paranoia was overpowering my rational mind”, making it “more difficult this time”.
He worried, “they were coming after me and I would lose my family,” he said. “It’s not real, but it looks so real, it’s scary and lonely.”
Zantop said that Agerton interrupted a telemedicine session that week to run outside and check the license plate of an unknown car, and he expressed suspicion of helicopters flying over the house and a man with a backpack passing by.
“I was surprised that you came back, honestly,” she said.
She increased her antipsychotic and added an anti-anxiety medication and two antioxidant supplements, but outpatient treatment was not helping enough, she said.
Emily Agerton said her husband’s paranoia seemed to be exacerbated by the fact that he was at their house, which they started renting just before their first psychotic episode, so he associated it with this trauma. During his second hospitalization, he told her that he felt safe. They plan to move out when the contract ends.
At the hospital, Zantop prescribed different antipsychotic and anxiolytic drugs. Six days later, he had improved enough to return home.
Ivan Agerton recently said he felt considerably better, with 90% of his paranoia lost. Your sense of smell is starting to come back. He hopes that this signals a lasting improvement.
It is unclear how long he will need the medication and when he will be able to resume his adventurous work.
“There is this fear of how long this is going to happen,” he said. “How long will I live with this?”
This article was originally published in The New York Times.
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