Lots of people complain of cognitive problems on or after taking medications, whether psychotropic drugs, cholesterol lowering statins, asthma drugs like montelukast, or fluoroquinolone antibiotics.
They often use the word “Brain Fog” to cover this. Women get Brain Fog in pregnancy that can linger afterwards. People with Long Covid complain of Brain Fog as do the Covid Vaccine injured.
Bri Dressen complains of it – see Injuries in Vaccine Trials – as does Nina – see 007 – who can tease apart different brain fogs – from Lyme Disease, concussion and after a vaccine injury. Several of the others whose cases will be outlined on Cause and Effect in the next weeks have the same problem.
No-one has been able to pin down Brain Fog. The term gets used when there is a general cognitive impairment that includes poor concentration or focus and a slowing of or inability to think clearly.
Drugs, Pregnancy, Infections and Vaccines induce Brain Fog but drug induced Brain Fog is different to some very clear drug induced memory problems drugs can also cause:
- Benzodiazepines have clear and easily demonstrable effects on episodic memory.
- Antipsychotics have effects on set-switching causing problems like difficulties in remembering the right phone number for the right person – when we used to remember phone numbers.
- Statins are linked to Transient Global Amnesia.
In contrast to these cognitive difficulties, a wide range of cognitive skills are retained in dementia, the classic example of cognitive failure – such as piano playing. Skills like these are based on procedural rather than declarative memory – on muscle memory rather than cortical memory.
When there is clear brain damage it is often possible to show problems on cognitive function tests. But cognitive tests don’t normally show abnormalities in people complaining of Brain Fog. The person insists there is something wrong with their brain which leads to scans and tests all of which come back normal. As a result, people complaining of brain fog risk being written off as having a functional disorder – which is code for hysteria or somatization.
These people with so-called functional problems include those in withdrawal from antidepressants, the vaccine-injured, or those with Long Covid, all of whom in the absence of a clear change on a test are likely to be dismissed as neurotic. This dismissal means their experiences don’t get recognized and this adds to their problems by making it seem the health system is against them – which to an extent it is.
The Brain Fogged give clear descriptions of their problems. They point to difficulties with routine tasks. These require greater concentration and attention than usual. This makes work and other things seem more effortful than usual. However, when tested on attentional tasks, working memory, or other cognitive tests they ordinarily do well.
Muscle Memory?
Cognitive psychology books don’t mention memory problems on drugs like SSRIs or Montelukast for asthma, but the adverse event reports to RxISK link both Montelukast and SSRIs with memory problems.
Another group of patients who complain of memory problems are those taking the fluoroquinolone antibiotics – levofloxacin and ciprofloxacin. The cognitive difficulties linked to Flox-Tox can be severe enough to give rise to frank disorientation. See Fluoroquinolones and not so Carte Blanche.
People on fluoroquinolones also report muscle wasting, muscle pain, and tendonitis. These drugs are the commonest cause of ruptured Achilles tendons. Almost everyone who has reported muscle and tendon problems to RxISK on whatever drugs complains of memory problems also.
People taking statins also complain of both muscle and memory problems. The muscle destruction (rhabdomyolysis) linked to statins is uncontested. But in addition to muscle problems, people on statins have cognitive problems. FDA’s database shows numerous reports of memory problems on simvastatin, atorvastatin, or rosuvastatin for instance.
On the RxISK database, as with patients on fluoroquinolones almost all patients on statins complaining of memory problems also report muscle problems.
Aside from clear cases of Transient Global Amnesia on statins, however, it has been difficult to bring statin related cognitive problems into focus.
In 2004, Muldoon et al reported on a controlled trial tracking cognitive function in patients randomized to placebo or simvastatin. There were no abnormalities on tests of executive functioning or declarative memory. But, patients on statins showed an impairment of learning compared with those on placebo – when retested after 6 months.
These learning impairments are consistent with an effect of these drugs on procedural memory. Procedural memory underpins the learning of skills, such as piano playing or typing.
In the case of piano playing, music teachers commonly refer to muscle memory. It’s the same with typing. Skills like this can be disrupted by muscle injuries and need new learning to put them right. In contrast damage to the brain as in dementia can leave these skills intact.
The combination of muscle injury and cognitive complaints found in fluoroquinolone and statin patients suggests a disturbance of muscle memory. Putting things right involves retraining muscles and movements rather than fixing brains.
Procedural memory?
Piano players who have obviously injured an arm or finger have to relearn skills. They do not complain of brain fog – because they can see the problem is not in their brain. Through endless practice they just need to get the injured finger to be in the right place at the right time. See Backwards Bike Riding – for a really great example of this.
People on statins, antidepressants and fluoroquinolones have extensive but subtle injuries to lots of muscles affecting many skills. These result in an unsettling experience – we get things wrong that should be second nature but we don’t have an obvious explanation for the problem.
Watching elite sportsmen like Tiger Woods or others lose their ‘feel’ for what was second nature to them always makes me wonder if they have been put on some medicine. Britain’s best footballer, Wayne Rooney, seemed to lose that extra something he had after taking Finasteride to manage hair loss.
As a result we have to pay more attention than usual and concentrate more than usual. This is effortful. This combination of effortful and poor performance despite clearly concentrating more than usual is what gives rise to the idea that what is gone wrong is in our brain. But when tested we will perform normally on all tests of executive memory function, attention and concentration.
The SSRIs are not linked to rhabdomyolysis or snapped tendons in the way statins or fluoroquinolones are. But serotonin was discovered in gut walls and its action as a neurotransmitter was also first demonstrated on gut muscle contractility. There is much more serotonin in gut than brain and the role of serotonin in voluntary and involuntary muscle contractility has been repeatedly demonstrated. There is abundant evidence for a range of muscle changes on SSRIs from dystonias of voluntary muscles to altered gut function both on treatment and in withdrawal.
Vigilance
This leads to a second element of Brain Fog. You might think our brains are there to scan the environment for dangers like wild animals or risks to life and limb. They aren’t. Ninety per cent of our brains’ attention is devoted to possible threats in our internal environment from our bladders, bowels, heart beats, breathing etc. Only ten per cent is worried about the Boss, World War III, or the tiger on the loose in the neighbourhood.
This is why it can be difficult to concentrate if we need to go to the bathroom or develop palpitations.
In the states that give us Brain Fog, there are things going on in the body that caputre our attention. Things that aren’t working right, which need to be monitored. It can be all the way from our vision – New Study of SSRIs and Vision – to missed heart beats, a racing heart, perspiration that has come out of nowhere, burning feet, and in particular gut and bladder effects.
Some of the comments after last weeks vision post are striking – how when a medicine like an SSRI disturbs some element of our vision, simply moving our eyes can trigger dizziness and electric zaps. No brain on earth is going to be able to concentrate normally when things like this are happening.
We can end up no longer sensing we are ourselves anymore – see SSRIs and loss of Identity – one of the posts that seems to resonate with a lot of people.
Our brain’s feel like they aren’t working right because they can’t control these things, which have normally been well controlled. But our brains are working just fine – all the tests confirm that. Far from working slow and with not enough focus, they are working overtime and are over-focussed but our bodies are overloading them.
Treating Brain Fog
In the case of piano players endless repetition in order to restore muscle memory can be the answer to restoring ‘cognitive’ function. There are great example of people like Bob Fiddaman getting out and walking as a way to get his body, or most of it, back in groove – enough to feel that he could recognise himself again.
We can control our voluntary muscles but its much more difficult to control our vision, our bowels, and bladder.
The image above has been a favourite of mine for decades when I could remember what it was like to have to try and co-ordinate breathing, eating and speaking at visits to a new girl-friend’s house. The more you try the worse things get – except in a real external crisis when you stop looking in and everything can seem to start working optimally again. Even patients with Parkinson’s disease can move fluently again if a fire alarm goes off.
Perhaps travelling to Ukraine at the moment, or hiking in the Himalayas.
Short of that, a key thing is to recognize that Brain Fog complaints are neither neurotic nor the result of irremediable brain damage. Print this off and give to your doctor or psychotherapist – and tell them there are no drugs will fix this and its not a matter for psychotherapy.
You will probably get more useful non-verbal input (tune the verbals out) from physiotherapists, occupational therapists and fitness therapists. This might be your excuse to get regular massages.
One key area is sleep. Like breathing, and swallowing, this is something we can’t control. Without becoming obsessive about sleep hygiene on the one hand, or taking sleep aids on the other, sticking to a routine here can make a difference that has knock on effects across lots of areas – see Forty Winks, and Insomnia, the Royal Road to Pills,
Appendix: Brain fog
Case 1: SSRI withdrawal
I have difficulty finding words or names whilst in conversation. I have to consciously think about what shape my mouth should be making, try and picture the word, its length and what I think it begins with. Sometimes I have to opt out of a conversation because I just get stuck. I may construct the thought in my head, but when it comes to speaking, I’ll completely forget what I was going to say. My brain has to work overtime to recollect the words and point of what I was saying. It doesn’t always come out how I want and is often simplified or doesn’t make any sense, but I can’t rectify any of it, I just feel really confused.
Asked to speak on local radio, answering questions, I have felt I speak nonsense but have been told I still do it well which is surprising to me. Having to consciously find words and what I want to say makes my head feel heavy.
I also have problems focusing on things like a flower. Instead of having the high definition vision I am used to, everything is more pastel and less defined. I have to consciously blink, open my eyes wide and focus in on things to see something clearly, but then its only momentary. Seeing the details in things was a strength in my art work. I was a person of detail.
I get irritated when I’m trying to watch something and someone talks at the same time. I think because it takes me so much energy to focus on one thing, if someone breaks that flow I feel I’ve lost where I’m at and it takes me time to re-focus. When I research things, I find that instead of reading something and making sense of it I have to re-read things to get a grasp of it and deconstruct a sentence so I understand the relation each word has to the other. Information doesn’t seem to stick in my mind very well anymore.
When walking the dog, doing housework, driving, going round the supermarket, it often feels like I’m living in a dream. I am aware of the general goings on but nothing really comes into focus.
I can be driving knowing one minute where I am going but the next moment I forget. Sometimes in supermarket I have to stop in my tracks because I’ve forgotten what I’m there for. I can be making a cup of tea and forget what stage I’m at – have I put the water in the kettle, has it been switched on? I’ve put cold water on a teabag a couple of times. I have to do a check list for menial tasks.
When watching television I often find I can’t focus on what’s happening. I may have to rewind it so I can try to make sense of it.
Social situations are distressing because I don’t always ‘hear’ what people are talking about, I know they are talking but I can’t absorb or make sense of what they are saying. Even more so when there’s more than one conversation going on at once, it takes energy to focus on one person.
I have sung for most of my life. I am good at picking up a song quickly; the tune and the lyrics. I am one of the singers in the band we have at church but have found that I have to remind myself more often the lyrics and if I’m harmonising where I’m meant to go on songs I’ve done loads of times.
I had been very good at multi-tasking at work. I can have several queries at a time and routinely do all at a fast pace, but now I struggle. I also make errors, despite my best efforts to take my time and double, even triple check things.
I can put a wash load on and forget temporarily which slot the detergent and which the conditioner goes in.
Case 2: Statin linked
My first experience of brain fog was when my secretary handed me a piece of paper with the new location and room number of a seminar class I was teaching. I read the piece of paper and the information disappeared instantly. By the time I got to the room, I had looked at the paper several times but could not remember what I had read each time – it just won’t go into my head. Had she not written the information down, I would have been lost.
The landscape seems cluttered and you can’t pick out things of importance you are looking for on your monitor, on a page. I can’t organize things in sequence. I can’t do subtraction in my head, or recall common words, people’s names, or birth dates. I cannot figure out how to draw or read a sketch map – trying to give or remember directions is almost impossible
I have great difficulty concentrating. It is very hard to read something all the way through, the eye moves along in a non-disciplined way and it is hard to read things in sequence.
It is very hard to keep track of things, put something down and it is gone one second later
All of this is associated with a low grade anxiety and fatigue because you can’t quite grasp what is going on.
This inability to concentrate or to think clearly makes it impossible both to follow a recipe in the kitchen or to teach or administer large classes, which involves coordinating with several teaching assistants. I couldn’t insure accuracy of lecture schedules, exam dates and contents and of course could not figure out what exactly was going on or why I couldn’t do the things I had been doing for years.
Bob Fiddaman says
I have an amusing story about putting gravy granules in my washing machine instead of soap powder. However, I can’t remember if I was on, withdrawing from, or had stopped Seroxat cold turkey when this happened.
Needless to say, the dogs in the area I was living at the time, loved me when I was out walking.
Withdrawing from SSRIs, in my case, Seroxat, was cumbersome. Looking back, most of it is a blur. We are often told alcohol, for example, kills brain cells that control our memory, I don’t know if this is a myth though? Seroxat definitely did (has) though. My short term memory is very poor, yet I can remember things from my childhood. I have met many old friends who cannot remember stories from our past – maybe SSRIs enhance the part of the brain that stores the old memories but depletes the part that stores the short term memories? – Don’t let the drug companies know that though or we’ll soon have a drug that will profess to keep old memories intact 🙂
You make a good point about Rooney, this never really occurred to me. Didn’t he, like Jimmy White, end up having Follicular Unit Extraction treatment?
Do people, who aren’t on meds, experience ‘Brain fog’? I suspect they do.
I think if we go down the concentration lapse route, it will be difficult to say one is caused by meds, another is just a natural (inevitable) human experience. How do we determine which is which?
Moreover, could medication-induced ‘brain fog’ be the very early onset of dementia?
Great post!
Dr. David Healy says
There is more to brain fog than lack of attention – but poor focus and concentration are big elements of it. They are also persistent elements rather than just episodic – linked to a clear stressor.
Viruses are another definite cause of the problem. SSRIs look like they can also advance dementia as can stimulants and other psychotropic drugs but again this is something different to brain fog
David
annie says
I think we have to obliterate nervousness from fog. As the little anecdote about going home to the girlfriend suggests.
Fog is a mist that doesn’t allow you to see, Smog is a huge thick saliva of deprivation of being under a drug-induced spell.
I can take myself back to being in my bed, under the covers for such a long time without me allowing anything to interrupt my smog-laden smorgasbord of wanting entire peace from anything that could intrude upon it –
Thinking about my day of plans after I woke up was what I was about.
I’ll walk the dog, then I’ll cut the grass on three lawns, then I’ll prep the food, then I’ll walk the dog again and then my young child will come home on the school bus and I’ll do some playing and we would have fun and then eat and then to bed and read for hours with favourite children’s storybooks – Where the Wild things Are – and drift off to sleep – with the optimism that tomorrow will be another great day.
Brain Fog from Seroxat is the cultivation of a medication invented by pharma to cause maximum harm to maximum people whose doctors will tell them they have mental problems which cause the doctors to put their patient in a straitjacket far and away from us living off ‘the drugs of life’ …
Seroxat earned GSK billions, on the gravy-train…
Dr. David Healy says
The point being made was not about stress and brain fog – but about the impossibility of controlling things by willpower or mindfulness that are not normally under voluntary control
The more we have to try hard to get our breathing or sleeping or even articulation right – the worse it gets
D
susanne says
U.S. flag
An official website of the United States governmen
Department of Justice
FOR IMMEDIATE RELEASE
Wednesday, March 9, 2022
16 Defendants, Including 12 Physicians, Sentenced to Prison for Distributing 6.6 Million Opioid Pills and Submitting $250 Million in False Billings
Sixteen Michigan and Ohio-area defendants, including 12 physicians, have been sentenced to prison for a $250 million health care fraud scheme that included the exploitation of patients suffering from addiction and the illegal distribution of over 6.6 million doses of medically unnecessary opioids. Five physicians were convicted in two separate trials, while 18 other defendants pleaded guilty. Seven defendants await sentencing.
“Patients look to physicians and medical professionals for their expertise and knowledge, trusting that they will do what is best to take care of them,”.” .”
According to court documents and evidence presented at trial, the scheme involved doctors refusing to provide patients with opioids unless they agreed to unnecessary back injections. Perpetrated through a multi-state network of pain clinics from 2007 to 2018, the evidence established that the clinics were pill mills frequented by patients suffering from addiction, as well as drug dealers, who sought to obtain high-dosage prescription drugs like oxycodone. The doctors working at the clinics agreed to work only a few hours a week to “stay under the radar” of the Drug Enforcement Administration (DEA), yet were among the highest prescribers of oxycodone in the State of Michigan.
To obtain prescriptions, the evidence showed that the patients had to submit to expensive, unnecessary and sometimes painful back injections, known as facet joint injections. The injections were selected because they were among the highest reimbursing procedures, rather than based on medical need. Trial testimony established that, in some instances, patients experienced more pain from the shots than from the pain they had purportedly come to have treated, and that some patients developed adverse conditions, including open holes in their backs.
The evidence further established that the proceeds of the fraud were used to fuel lavish lifestyles.
susanne says
One very common menopausal symptom is ‘brain fog’ It is still poorly understood. It is so distressing many women fear it means the onset of dementia. Anti depressants (amongst other stuff like HRT are prescribed ) – they can cause brain fog – (also heart problems, another risk of taking vaccines) Vaccines are welcomed by some but also mandated – they can cause brain fog. Is anyone doing any research or warning older women of the possible consequences of adding vaccines into the mix. Probably not.
Snippet from the web
‘In perimenopause and the early stages of menopause, women describe changes in their ability to think clearly, make decisions and function well mentally. Some describe this as “brain fog”. They may experience difficulty assimilating and making use of new information.’ (But no relevant information is being given to older women anyay)
Pogo says
This is the first really comprehensive description that I’ve read of what the experience of brain fog is like. Well done to the writers.
I found my body’s dysregulation (things beyond conscious mental control) moved through phases. First I noticed vertigo, even from looking out of an upstairs window. Weeks later I remember that for a few days at a time my food passed through me undigested. Other times I had diarrhoea. Strong codeine tablets (30mg) thrice daily helped and also toned down my other symptoms a lot, for reasons I’m not sure of. Some months after those episodes had passed I’d brake out in a sweat so profuse that is would drip from my fingers and leave me soaked wet. Following that, my feet burned so I walked barefooted for weeks. I suffered from POTS and the other symptoms mentioned. For a fortnight my thyroid would seemed over active, giving way for two weeks of under active adrenal glands and the cycle would repeat. I don’t remember any problem with muscle memory as such, although I completely lost the ability to write legibly for a time and still need to concentrate even now. Mental subtraction ability hasn’t returned and mathematical notation remains almost meaningless. Regarding this. The ‘invisible void’ in my mind, for certain lost abilities, reminded me of things I’d read by the renowned neurologist Oliver Sacks, where he described some stroke patents (with unilateral neglect I think it was) who only ate their food on one side of the plate. The neurons that used to processes that information had died and they were even unaware of this deficit existing. For them them, the other side of the world, not just the plate, did not exist. This lead me to think that my brain-fog experiences are due to parts of my neural network slowing down and sometimes not working at all. And they seem to take turns at it! I’ll discus a problem I’m having to someone and the solution then becomes obvious! It is though part of my ‘executive function’ is missing but by talking to someone else I can bypass the deficit. Noticed time and time again that it was with novel problems. If it concerned something I had done before then it was easier to do. Tried to fall back on mental prosthetics such a Mind Mapping (as popularised by Tony Buzan) but I could no longer map out on paper, possibilities which I could no conceptualise in my mind. It was and is very frustrating.
As my brain fog is due to myalgic encephalomyelitis (ME/CFS) and not drugs, that suggest to me that the common factor present in both drug induced BF and ME/CFS BF is neuroinflammation. Its frustrating that research isn’t looked into BF from these drugs, for without a proven -itis it is a bit unprofessional for a doctor to just to try things out, hoping something might work. Perhaps a blood test to look for biomarkers of inflammation might help but in ME/CFS such test often prove too insensitive to show up anything abnormal. The problem with looking for antibody biomarkers is that that there are so many possible antigens to choose from and having antibodies to something may be from a past infection anyway.
What would be interesting to know is how the symptoms changed over time in others but from the medications. The reason I enquire is that as I was getting over the worst of it, I was retrospectively going over my symptoms and looking at my text books on brain anatomy. Had not not yet been diagnosed with ME/CFS back then but my hunch was that ‘something’ was spreading slowly, brain function by brain function, until it got to my visual cortex. Trying to unpick the knot. Can some drugs and vaccines lower the immune system enough to allow a slow smouldering encephalitis virus to take hold or do they cause inflammation directly or is this barking up the wrong tree altogether?
I mentioned in a previous post about future possibilities of using radiolabelled ligands to image the sites of inflammation but at the moment this is too expensive. For interest though, here is a link about it:
Neuroinflammation and Cytokines in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A Critical Review of Research Methods https://www.frontiersin.org/articles/10.3389/fneur.2018.01033/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Neurology&id=421061
The paper also explains the role of brain microglia and it is thought in ME/CFS that it is the activation of these (by pathogens) that make the nerve cells hyperactive giving rise to heightened sense of smell, hearing, light, and pain. Not all occurring at once though in me, they took turns on being excruciating.
Of all the treatments I’ve read about (for ME/CFS), it has not been clear, due to the small cohort size and methodology, whether the treatment really sped up patients recovery/improvement or whether they would have recovered/improved over the same time, without treatment. Also, no one treatment protocols seems to work for everyone. However, it seems from my personal experience that many treatment do make people feel they are improving and make symptoms more bearable so I would not want to put off anyone trying them for illnesses with similar symptoms but from other causations.
Dr. David Healy says
Pogo
It doesn’t have to be neuroinflammation. Viruses mostly don’t get into the brain. SSRIs act mostly on the body as do isotretinoin and finasteride and the antibiotics that cause it and statins. Bodily malfunction, especially of our internal organs rather than an obvious injury to a limb is guaranteed to cause problems. This doesn’t mean neuroinflamation and other factors can’t also cause problems
D
Pogo says
The gist of what I was trying to ask or suggest, I appear not to have put simply enough.
Regardless of the underlying biological abnormalities caused by medications, viruses, bacteria, pesticides, etc. Why not try to reduce those symptoms of an unbalance biology which can be reduced, to improve the quality of life for the sufferer!
Old med text books have many out of date theories.
More and more research is finding evidence that out of balance immune systems with inflammation are behind many psychiatric conditions in subsets of patients. Even in major depressive disorders. [1]
As we are a mixed subset of the population we experience what the doctor who first defined the term allergy Clemens Von Pirquet would describe as “an altered capacity of the body to react to a foreign substance.” For whatever reason the body gets damaged the immune system gets involved. Inflammation must have manifested. Biomarkers don’t appear for no reason at all and nether do these symptoms. It doesn’t matter at the basic level, identifying what the hypersensitivity reaction type is (and it may be more than one) but there are many avenues of treatment known to help modulate the immune system. Also, it is understood that some foods and some chemicals can exacerbate a struggling immune system. Once identified these can be avoided but often they aren’t obvious, so have to be searched for by trial and error but how many doctors take this seriously or can give advice. It is more a question of finding protocols (which may need changing from time to time) that makes life for each individual better than it might be otherwise.
OK back to the ‘body’ and finasteride etc. Its published hypersensitivity reactions are: “Rash, pruritus, urticaria, and angioedema (including swelling of the lips, tongue, throat, and face)”. Therefore, in rarer instances there are bound to be more immune reactions than these. If one of these reactions also makes the blood brain barrier leaky, as is common when the immune system is thrown off balance, then not only the body but the brain can be affected. Be it by viruses, bacteria, aluminium adjuvants (in some vaccines) or other immune components such as inflammatory cytokines (these are what cause the low grade feeling of flu with aching muscles) they can all pass through into the brain, all of which in turn — can activate the microglia. And so we now, have brain inflammation as well!
Therefore, doesn’t it make sense (even if only for palliative reasons) to place more emphasis on actively tackling the inflammation (which must have manifested) arising out of adverse drug reactions, whilst a cure is being searched for?
Is it that modern medical training blinkers doctors to proscribing one drug for one indication and if that doesn’t resolve the issue, repeat the prescription until the patient is on multiple medications from a knock on effect. The herbalists like Nicholas Culpeper, ayurvedic and traditional Chines medicine practitioners often proscribe changing formulations of many herbs, diets, physical exercises and so on. They modify their treatment by results (this is not done haphazardly but to a rational) and then stop once their patient feels better. [I too, only self-medicate for sort periods so to monitor how I’m doing. If I take a break for too long I slide back.] When treating something as complex and changeable as the immune system, doesn’t this demand this same flexible approach — even in this modern age?
This not to expect a total cure and there is the problem of what doctors can prescribe without running the risk of attracting accusations of malpractice. Yet, there are a lot of treatments that if wider known and taken in the right way can and does reduce brain fog in some people.
So to answer this article’s title more explicitly this second time around. Try treating brain fog by trying anything and everything (including exercise) that is know to reduce inflammation.
[1] Kopschina Feltes P, Doorduin J, Klein HC, et al. Anti-inflammatory treatment for major depressive disorder: implications for patients with an elevated immune profile and non-responders to standard antidepressant therapy. Journal of Psychopharmacology. 2017;31(9):1149-1165. doi:10.1177/0269881117711708
https://journals.sagepub.com/doi/10.1177/0269881117711708
Dr. David Healy says
So how do you reduce the symptoms of an unbalanced biology – throw more drugs into the biological mix? This is a recipe for disaster. Its one things to throw a poison into biology having a rough idea of what we are trying to do but another thing to throw drugs into a mix we know nothing about.
The idea sketched here is that the biology is more likely to heal itself – if its still possible The one thing we can do is try and pay no heed to it because most of the things that are going wrong are not helped by paying attention to them – so its important to get out and walk or whatever might promote the normal biological turnover and distract us so that we will not get distressed and by meddling make things worse – all in the hope that this will promote recovery
D
Vee says
As you all know, willingly or not, the DSM and ICD are money making machinations based solely on non-biological foundations or in other words, based on symptoms … iatrogenic symptoms caused by drugs, medicines, prescriptions, therapies, interventions, and so on
Who in these posts has shares in the drug trades including big pharma and subsidiaries and associated research institutions … ?
Daniel says
Dr. Healy, i took damage from ssri withdrawal repeatedly over a long time before figuring out the medications were the cause. I worry that psychiatry has issues with much of harms will be undiscovered by both studies/trials (bias from conflict of interest, correlation only, not asking the right questions etc..) and clinicians also miss that patients were harmed by meds i think. Correct me if i’m wrong, but studies of ssri iatrogenesis have taken an eternity to establish withdrawal as a separate phenomenon from relapse to depression, a recent study even found that UK guidelines for differentiating between them clinically, has clinicians labelling withdrawal as relapse, blaming medication harms on illness. When you try to approach it like an alien, i think the whole idea of a clinical trial begins to be quite absurd: gather a large group of people, have researchers create a change in a subset of those people but create a placobo intervention in the other, which may or may not adequately enable correcting for psychosomatic effects, to find out an average effect on a group (as defined by diagnoses consisting of subjective judgements of psychiatrists defined by vague and imprecise concepts, with no biomarkers for it, it will be a biologically heterogenous group) ,that is in the short term on symptoms that cannot always be discerned from harms from medications ,except that the studies dont always in practise show that reliably at all and you need to make several in order to be certain. All of it to find an average effect which is used to avaregely guess safety and benefit to an individual under conditions which very likely wont be true (the person could be older than trial subjects, be on multiple medications, longer than the trials, be an unrepresentative patient). Why such a complicated statistical machine? ..to find out improved variables which you cannot even know whether to be signs of health improvement or symptom dulling dangerous health-harm!Add to that that it is done often by researchers with ties to pharma, what could go wrong? I dont know if you agree on all of this description, however i think that these problems might be easier solved by finding epigenetic biomarkers for iatrogenic harm, maybe by using machine learning to find patterns epigenome in harmed vs unharmed subjects/patients, something that you might be able to measure objectively with biomarkers unlike the illness themselves, it might help to be able to measure harms more directly in research, without all of the information loss and uncertainty and statistical tricks, you could perhaps even use it preventively clinically to know when to stop before a patient takes more damage. Maybe used in courts to determine if iatrogenesis caused a murder. I heard you said in a podcast that treatment often becomes illness and given more treatment to combat that illness, i dont think that is a sane state of medicine.I thought about telling researchers in those fields about the problems with evidence based medicine and iatrogenesis in psychiatry, and how objective biomarkers would probably help. I am not an expert in these things i figured i might ask you and others if epigenetics could be used to study/monitor clinically the problem of iatrogenesis, is it feasible, have you looked in to it?
AC says
Totally agree that throwing more pills at ‘withdrawal’ probably cause more problems.
In 2017,after a 2 year taper I was finally off benzos, (I had been on them 32 years). The tapering had been really tough, but I had remained functional. I had also been functional throughout the years I was dependent on benzos.
I felt sleepy and sedated on benzos, I felt my gait and thinking processes were slowed down yet I could drive and was a busy teacher.
When I jumped off the benzo (At 0.5mg) things seemed OK, but within 3 weeks I experienced brain Zaps and a tingling in my extremities including nipples and genitals. At the time I had no idea what brain Zaps were. I remember the Nurse in the AndE smirking as I tried to say what was going on. I said I had a zizzing in my head, hands, feet, nipples genitals… They took bloods and put an ECG on me. I did tell them I had just come off benzos but was told this was not related to that!
As the month continued I began to experience derealisation, depersonalisation. Again I didn’t know what this was.. This can feel like brain fog. Is DP/DR psychological or Physical? An inner restless developed as did severe insomnia. My brain could feel like it was racing, at other times I felt slowed, ethereal spaced out. As the New Year dawned I became more and more dysfunctional, I couldn’t think straight, I struggled to concentrate and I found speaking fairly pointless. For the first time in my life I knew I could not work.
At this point my husband took me to the Dr’s, he did most of the talking. They diagnosed G. A. D. and treatment resistant depression. At this point I had been off benzos for 4 months. The only thing I was on was 100mg Sertraline. But due to the above diagnosis I was taken off Sertraline and put on Mirtazipine, when that didn’t work I was prescribed melatonin, as my severe insomnia increased I was prescribed quetipine.. Luckily it made me psychotic so I stopped taking it. By Sept I had been taken off Mirtazipine and put on 225mg Venlaflaxine. Pregablin was added to the mix. I think the chopping and changing of Meds made things worse. I did not know about Polypharmacy at this point. No member of the medical profession agreed with me, that it might be benzo withdrawal…
A year later I began my fight back,
The ‘damage’ felt as though it was in my brain, but I think this was because of the pressure, especially behind the eyes around the temples. My neck, shoulder and jaw muscles were still very tight. This made me feel dizzy, which in turn made me feel un-co-ordinated. I had not driven a car for 18 months… Interestingly my gut and bowels had been fairly OK throughout all this chaos,The same could not be said for my bladder. I noticed although the muscles in my shoulder, neck, jaw eyes remained tight. The pelvic floor muscles were extremely slack (The same area used in female orgasm)
I decided to try and taper off pregablin and venaflaxin. Pregablin certainly makes you think you have brain fog.
Today I am down to 24mg of Venlaflaxine and down to 25mg of Pregablin.
I am not 100% confident I can risk coming off either completely.
Today I do not have any gut or bladder problems, my pelvic floor muscles seem alot stronger, libido much to my huge surprise seems to be getting better. I still have some pressure in my head, a dull tension type headache, some muscle tightness in my neck, no longer in the Jaw. Eyes can feel strained.
I still don’t drive as fear my co-ordination, dizziness, concentration is still not good enough. But suspect if I had to drive I probably could.
Prescribers still are choosing to remain ignorant/obtuse about helping people taper… I have not seen a Dr since 2018,choosing to withdraw quietly and secretly.
It is and remains a lonely, hard tough journey…
AC says
This morning on Good Morning Britain see’s Dr Raj (A celebrity Dr) maintaining that due to brain fog from long Covid he no longer has the energy to work in A and E, he lists the symptoms as tiredness, lack of concentration, easily fatigued, an inability to multi-task.
Dr Raj suggests anyone who thinks they have brain fog (From Covid) should tell their GP, who will refer them to one of 90 long Covid clinics! There was also a websight reference for further help, information.
I could be tempted to ‘pretend’ my brain fog (drug induced) is a result of long Covid… There clearly is ‘milelage’ in that. If you told a GP you had brain fog from drug dependence or withdrawal you are likely to not be believed and labelled emotionally liable, FND, MUS etc etc..
Dr. David Healy says
This is a great idea. Everyone should go along to long Covid clinics and pretend and see what happens
D
susanne says
What if Raj P is pretending. He’s not been above doing a bit of pretending but has still done alright in the coll of psychs
Plagiarism and suspension
In 2008, Persaud was suspended from practising psychiatry for three months by the General Medical Council, having admitted being guilty of nine cases of plagiarism. He subsequently left his consultant position with the South London and Maudsley NHS trust.
His book From the Edge of the Couch contained material plagiarised from four academic articles written by nine authors. Four of his articles also contained plagiarised passages from an article and book by Thomas Blass, The Man Who Shocked the World.
AC says
https://heiw.nhs.wales/covid-19/long-covid-syndrome-resources/
Well, well, well….. Susanne, Just look at at all the help, guidance, even NICE guidelines, given.. Contrast this to help advice given for symptoms connected to drug, dependence, drug withdrawal…
Milorad says
I was misdiagnosed that I was depressed (which i wasnt), and took Paxil for 3 weeks. I experienced in 3th week memory loss, problems with concentration, soft penis, weak erection, bad sleep… and 12 years from last dose, I still have those symptoms. Not that intense, but I would say I recovered around 40%. So 12 years I have PSSD, cognitive and sleep problems. Im not my old self. It changed me. Maybe permanently. I live my life, but its not like before SSRI. If I know that there is a slight possibility that I could be damaged like this I WOULD NEVER EVER took that drug. The question is could be this fixed..? Not everything, and every damage done to human body and mind could be fix… But there is hope still… who knows…
Vee says
We are in the minority.
Many of us are not wealthy enough to fight back.
And those who are financially flush value their status and power and standing and lifestyle as being more important than anything else.
Why twenty years on are we still repeating the same conversations!
Why twenty years on has nothing much changed in our favour?
Why are problems being drugged up with higher and higher doses of toxic products.
The human body cannot be itself divided up into systems and specialties. It is one whole organism. Only in text books and so on is it possible to single out one element (micro / macro/ or other) of human function and pretend that it is not interrelated to any other! Regardless of degree.
Fiona says
Is it possible to have brain fog, and at the same time, feel like your head is in a constant car crash and tinitus? I believe it to be from prescribed antidepressants for nearly 40 years. Or, is it as a result of adverse childhood experiences? I struggle to hear people when they are talking to me. I struggle with my memory. Daily tasks are exhausting. I get the impression that some people dont think that i am capable, because i struggle to grasp things, but i know that i am very capable.
I have had responsible jobs, and i have been a valued employee, but i am at the point that i cant push my brain anymore for fear of damaging it. Its like if a leg hurts, you need to rest it, well i need to rest my brain, my head, because it feels full of pressure. Or is it anxiety?
I have been taking venlafaxine for 4 1/2 years, originally 150mg, tapered to my current dose of 100mg over the past 2 years. When i havent felt well, I have been switched from one antidepressant to another, because there was nothing medically wrong with me.
Brain fog is my worst symptom/WD/side effect. I will not take any more mind altering prescription drugs.
So what are the remedies for brain fog please?
Darko says
Hello David,
I wanted to tell you my story if my description could help your research or to future research team, or maybe you can tell me your opinion on my situation?
Back in 2010. I was foolish to take Paxil for low self-confidence thinking that that could help me. I was 21 years old back then. I was perfectly healthy male, and didnt really need that drug.
I was on Paxil for 2 or 3 weeks. During that time I had restless leg syndrome or I see it now its called Akathisia. I couldn’t sleep, moving my legs and arms all the time. Been to doctor and she said that I should continue SSRI Paxil it needed time to work. I did took it for about 2 or 3 weeks, and in second week I started to to lose concentration, had memory problems, couldnt remmember common things and everyday things, numbers, peoples name and so on. I STOPPED paxil right away. Went to the same doctor and she wanted to put me of Zoloft.. I rejected and said that this drug did something to me and my memory. I never ever been on any medication since then, the only medication I took is antibiotics once a year when i get common cold.
But, I want to tell you my experience when I quit paxil and about condition that is lasting still 12 years since last dose of that SSRI.
Since the last dose of ssri, my memory and concentration are not as good as before SSRI, sleep also, erection is weaker then before SSRI, my muscles are weaker and softer.
When I stopped paxil I remmebre that first the tip of my penis become softer then the whole penis and whole body. Because I play piano, feelings in my hand and finger changed. Its like Im always fatigued and I dont need time to warm up, It hard to explain, but the feeling is different. After exercise, if I didnt workout for long time, I would get muscle inflamation. But, after SSRI I just cent get muscles inflamation because Im tired all the time.
It like I cant forget the things that I know, but have difficulties to learn new things.
I love to watch movies, before SSRI i would remember movies that I have watched, after SSRI I cant remmeber what movie did I watch, and every time I watch a movie I had dificulty to remember the story of the movie.
I dont feel that much passion towards music and playing, like I had before SSRI. It reduced. That passion is reduced.
Back then I been to around 30 doctors, tried to figure out what that drug did to me. When I would go to doctor and said I took Paxil they would immediately dismiss me, telling me its in your head. So, I had to leave that part that I took SSRI, and just tell my symptoms. I did all sort of tests, MRI head, EEG, EMG, blood work, hormones, viruses, allergy, autoimune, gut health, vitamin tests, … and ALL test were OKAY. I didnt know about PSSD, no body knew to tell me about this.
I have read theory about SSRI causing peripheral sensory neuropathy, and now that makes a sense to me.
I would say because I stopped after 3 weeks and didnt took another SSRI , that I have mild version of PSSD. Still to this day I have lower concentration, memory, sleep is also better but not like before SSRI. Still feelings in hand and fingers are that my hands and legs are lighter, not firm as before, and strong as before ssri. My erection is not as hard as before, its at around 80%. Also, the shape of penis is a little changed, there is a little arthery that is pulsating, from the side, and when Im tirred I have a little dificulty filling with blood the tip of my penis.
ALSO, sorry but maybe this one detail could mean a lot: before SSRI, when I would get exited I felt my hear would beat strongly and I would get that pulsating feeling in my penis, and erection would naturally come to full. After SSRI, there isnt that pulsating feeling and connection with heart. I have to manual with hand assist my erection to become. That has to be something with the nerves.
Sorry for taking so much time.
Michael says
I had a brain fog, once withdrawn from SSRI. Brain fog lasted over 6 months, since last dose of antidepressant. Brain fog is a nasty condition. I have tried multiple medicines to combat this issue. Finally , it was fully solved by sodium valporare (3 days, maximum dosage). Sodium valporare is a Hdac inhibitor.