Psychiatric and psychotherapeutic recommendations for long/post-COVID and ME/CFS: a narrative review of international guidelines

Abstract

BACKGROUND: Long/post-COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are often accompanied by fatigue, cognitive impairments and psychological symptoms. Psychiatric and psychotherapeutic care is challenged by unclear evidence, symptomatic overlaps, and controversial treatment recommendations. OBJECTIVE: Presentation and comparison of psychiatric and psychotherapeutic recommendations in relevant international and national guidelines on long/post-COVID and ME/CFS, focusing on psychotherapy and psychopharmacotherapy. METHODS: A narrative review was conducted. National and international guidelines focusing on ME/CFS and long/post-COVID published between 2020 and 2025, particularly by the WHO, AWMF, NICE, CDC and IQWiG, were included. The selected guidelines were analyzed in terms of key aspects. RESULTS: Psychiatric pharmacotherapy is recommended only for comorbid disorders. Psychotherapeutic interventions are mostly recommended as supportive in the guidelines. Activating treatment approaches, such as graded exercise therapy (GET) are generally viewed critically in connection with postexertional malaise (PEM), whereas for patients without PEM, several guidelines explicitly endorse moderate, individually adapted activation. Pacing strategies are highlighted across guidelines as a central concept of activity management. DISCUSSION: Psychiatric and psychotherapeutic interventions in long/post-COVID and ME/CFS are supportive but not causal treatments. Guidelines recommend symptom-oriented, individualized therapeutic approaches as well as an integrative consideration of somatic, social and psychological factors in the sense of the biopsychosocial model. There is a high need for specific research on psychotherapeutic intervention forms in these patient groups.