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.
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.
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.
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.