Depression and brain fog: when basic tasks seem impossible
*this name has been changed
Brain fog — also known as cognitive dysfunction — is a common symptom of depression that can seep into more than one aspect of someone’s life. It can make each day seem like a whirlwind of confusion, sadness or numbness, and cause a deep lack of energy. This can make the simplest of tasks, like showering, brushing your teeth, or simply getting out of bed incredibly difficult.
Cognitive dysfunction is defined as the slowing or impairment of both ‘hot’ and ‘cold’ brain processes: the former refers to thinking that’s influenced by emotions, and the latter to thinking that isn’t.1 Depression can result in the malfunction of both hot and cold cognition, affecting our ability to effectively plan and strategise at work and home, as well as our regulation of emotional responses.2 This can cause us to react with extreme distress in situations we’d normally respond to differently.
Consultant psychologist at Priory Hospital, Dr Liam Parsonage, describes brain fog as like a hefty “dark cloud”, where “everything, even thinking, can be an effort.”
“It’s a struggle to find the energy and motivation to do everyday things such as the weekly shop at the supermarket or cleaning the house,” he says. “People with depression often find it very difficult to make decisions and often find themselves going backward and forward over the same question, never being able to find the right answer, making it incredibly difficult to get everyday things done, such as paying the bills.
“This will commonly have a negative impact on their overall sense of wellbeing and their quality of life.”
What causes depression-related brain fog?
The reasons why depression and brain fog occur are multifaceted. Current research suggests that there are a combination of nurture and nature factors at play, which could include early childhood trauma or a family history of depression.3 Dr Parsonage points out that typically, the core symptoms of depression are “low mood, a lack of energy, and a loss of interest and enjoyment of life”, and views brain fog as a secondary symptom that is worsened or caused by these initial symptoms.
“A person suffering with depression will often feel very tired or exhausted after even minimal effort,” he says. “Physical symptoms of depression can include disturbed sleep, loss of appetite, and poor concentration. Depression will commonly have an impact on someone’s ability to carry out everyday tasks in the usual way.”
Dr Elena Touroni from the Chelsea Psychology Clinic explains that there are different schools of thought within psychiatry: some that lean more towards biological factors, like a lack of serotonin being the cause of depression and brain fog, while others lean more towards it being to do with trauma.
“People who are prone to recurrent episodes of depression tend to share certain characteristics commonly,” she says. “This could be a biological disposition due to a chemical imbalance, particular psychological experiences that make them more vulnerable, having very high standards for themselves, and perceiving that there’s a huge gap between the life they think they can achieve and the life they actually want, which brings on a huge sense of failure.”
“How I was feeling was difficult to describe to anyone — it was like being physically trapped by my body and mind, getting out of bed or going to make breakfast became these colossal tasks”
She says that the more severe a depressive episode is, the more likely you are to experience brain fog and its effects. She also highlights depression as something that’s experienced physically as well as emotionally, making it particularly debilitating and often presenting as “a flood of negative thoughts, feeling completely drained, and staying in bed all day”.
Charlotte*, a 26-year-old who was diagnosed with depression two years ago, said her initial symptoms were feelings of numbness and indifference, before lethargy, extreme tiredness, and lack of motivation to even complete basic tasks set in.
“To everyone else, I just seemed lazy and incapable, or as if I didn’t care about my responsibilities,” she explains. “How I was feeling was difficult to describe to anyone — it was like being physically trapped by my body and mind, getting out of bed or going to make breakfast became these colossal tasks.
“I sometimes ended up in tears, frustrated that I couldn’t get through the most basic of tasks, and feeling shame and anger about the people I was letting down, or the domino effect it was having on my career and social life.”
While deeply demoralising, Charlotte’s experience isn’t unique. On a surface level, it’s common for close friends, colleagues, and family members to misunderstand some depression symptoms as ‘laziness’ or ‘shirking responsibility’. Dr Touroni stresses that this reinforces the cycle of feeling guilt, shame, and worthlessness, which often sits at the core of struggling to start or complete tasks.
She also highlights early childhood experiences as something that can increase the likelihood of experiencing depression later on in life. Charlotte recalls often feeling eager to please, overwhelmed and invalidated around the age of nine, as well as dealing with the terminal illness of a parent, that made her feel a loss of control.
“During that time, it seemed like I was losing my grasp on anything valuable or positive in my life,” she says. “Through therapy, I’ve realised that the very same feeling I felt when I was nine often presents itself before a depressive episode, and that it’s linked to unresolved trauma.”
“Often because of early experiences, people who experience brain fog as a result of depression tend to think they’re not good enough in some way — it’s an issue of self worth, with feelings of an underlying defectiveness”
Dr Touroni says that research echoes Charlotte’s experience, indicating that early childhood experiences of trauma or feelings of inadequacy fuel the development of depression, with a surge in these feelings often underpinning the onset of a new episode.
“Often because of early experiences, people who experience brain fog as a result of depression tend to think they’re not good enough in some way — it’s an issue of self worth, with feelings of an underlying defectiveness,” she says. “If that’s part of how you experience yourself, because of early trauma, a relationship breakdown, or the loss of a job, you become more at risk for depression and consequent brain fog.”
These feelings being reinforced throughout someone’s early years, school years, and teenage years increases the likelihood of depression, explains Dr Touroni.
“Brain fog can set in with depression once you start feeling like you have never felt any differently, and that you will never feel any differently,” she says. “It then becomes hard to imagine that your mood will lift — it’s a very all-consuming state.”
What help is available?
Selective serotonin reuptake inhibitor antidepressants (SSRIs) — a class of drugs that increase the amount of serotonin in the brain — and cognitive behavioural therapy (CBT), or a combination of both, are the most common forms of treatment for depression, and depression-related symptoms, like brain fog. CBT is a form of talking therapy that aims to retrain your thinking processes. Therapist Sally Baker says that SSRIs tend to give people a small burst in energy that can be just enough to give them the motivation to start talking about and reworking their thought processes.
“Antidepressants and CBT can help you to find the edges of that grey fog,” she says. “Medication tends to give you just enough of a lift to begin therapy and start making changes.”
Neurology doctor at the Mayo Clinic, Dr Hannah Betcher, “very often” recommends psychotherapy with medication. “The skills you learn in psychotherapy can be helpful in the long term,” she says. “CBT and behavioural activation therapy have a lot of proven research behind them. They are about recognition and reinforcement in a positive way, helping you to focus on what you were able to do that day.”
Dr Betcher also adds that while generally, the way somebody experiences depression doesn’t tend to be gender-specific, women are more likely to internalise their negative feelings, which can exacerbate secondary symptoms like brain fog as a coping mechanism. She points towards big hormonal changes — like post pregnancy, or during menopause — being a trigger for depression in women, too.
Seeking treatment early isn’t always possible, as the signs aren’t always obvious, and feelings of shame and confusion might make it difficult to actually take the steps towards treatment
Dr Touroni says that while antidepressants offer relief for some, not everyone responds to them, which can be extremely disheartening, “especially if they’d placed a lot of hope on them to help with their depressive symptoms, like brain fog”.
Depression is recognised as a public health issue within the UK, and has been linked to negative physical health outcomes in later life if experienced as a teenager.4 Dr Betcher echoes this view, as well as highlighting the financial and socioeconomic impacts depression can have for individuals, particularly women, who she stresses are already at a socioeconomic disadvantage to begin with.
“Brain fog can cause you to lose the drive to complete short and long-term goals,” she says. “If someone is not caring for themselves, not able to shower, eat properly, or maintain important social and work ties — this can have a huge negative impact on their housing and living situation.”
Dr Parsonage stresses that depression is more easily treatable the earlier it is identified. However, seeking treatment early isn’t always possible, as the signs aren’t always obvious, and feelings of shame and confusion might make it difficult to actually take the steps towards treatment.
“We all experience ups and downs in our mood and have good days and bad days, but if the bad days seem to continue for more than a couple of weeks, it’s probably worth having a chat with your GP about it,” he says. “Your GP will assess your condition and decide with you on the most appropriate treatment options.”
The head image features water, rocks and a woman in a position that implies she’s falling, symbolising brain fog and depression, along with white squiggles to indicate frustration
Page last updated August 2019
- Forum on Neuroscience and Nervous System Disorders, Board on Health Sciences Policy, Institute of Medicine, and The National Academies of Sciences, Engineering, and Medicine, ‘Enabling Discovery, Development, and Translation of Treatments for Cognitive Dysfunction in Depression: Workshop Summary’, National Academies Press (US), Washington (DC), October 2015, Chapter 2: The Burden of Cognitive Dysfunction in Depression. Available from: https://www.ncbi.nlm.nih.gov/books/NBK327047/ (accessed 28 August 2019)
- NIMH, ‘Depression’, National Institute for Mental Health, [online], https://www.nimh.nih.gov/health/topics/depression/index.shtml [Accessed 28 August 2019]
- Keenan-Miller, D., Hammen, C., & Brennan, P. (2007). Health Outcomes Related to Early Adolescent Depression. Journal of Adolescent Health, 41/3: 256-262.