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Brain Fog

What Everyone Should Understand About Brain Fog

Possible causes include MS, depression, and long COVID.

Key points

  • Chronic brain fog can cause difficulty focusing, recalling information, and paying attention.
  • How and why brain fog occurs is still not fully understood, though it is connected with several illnesses.
  • There are both pharmacological and nonpharmacological interventions that can, in some cases, reduce symptoms.

We’ve all been there. You have a bout of insomnia and there’s no amount of caffeine that will clear your head in the morning. Or you take an antihistamine for your hay fever and it leaves your mind feeling a bit groggy and sluggish. This is what many describe as “brain fog.”

For most of us, this type of sluggish, fuzzy, or blurry feeling goes away after we get some rest or stop taking an antihistamine. But what if your thinking doesn’t return to normal? What do you do if you find yourself dealing with chronic brain fog?

There are many causes of chronic brain fog and while currently there are no FDA-approved medications for treating it, some antidepressants, psychotherapy, and at-home remedies may reduce the symptoms.

Causes of Chronic Brain Fog

Brain fog is a lay term used to describe the perception and experience of mental fatigue associated with cognitive impairment. Brain fog is not fully understood and often is described as slow thinking, difficulty focusing, confusion, lack of concentration, forgetfulness, or a haziness in thought processes.

Brain fog is not a diagnosable medical condition, but a term often used to describe a variety of symptoms including difficulty with:

  • Learning new skills.
  • Recalling information and words.
  • Handling periods of multitasking.
  • Thinking and responding quickly.
  • Focusing and maintaining clear thought.
  • Following conversations and paying attention.

While it is normal to experience some fuzziness when you are sleep deprived, taking certain medications, jet-lagged, or pregnant, experiencing brain fog for longer than a few days (or months, in the case of pregnancy) may be a sign of a serious medical condition.

Brain fog is a very complex phenomenon and the exact etiology remains unknown. Although the medical community is still researching potential causes of brain fog, it has been associated with elevated markers of inflammation and the presence of multiple autoantibodies. Overactive immune responses triggered by virus infections, autoimmune diseases, and immunotherapies can lead to immune dysregulation systemic inflammation, multiorgan dysfunction, severe fatigue, neuropsychiatric symptoms, and other conditions.

Certain diseases can affect your brain, resulting in the symptoms described above. Here are a few common causes of chronic brain fog:

1. Multiple Sclerosis (MS)

This disease affects your central nervous system and can interrupt the way your neurons communicate with the rest of your body. About 50 percent of people with MS have trouble with memory, attention, planning, or language.

2. Chronic Fatigue Syndrome (CFS)

This condition is complicated and characterized by experiencing extreme fatigue that isn’t improved by rest for at least six months. Those with CFS may feel confused, forgetful, and unable to focus for long periods of time.

3. Lupus

Lupus is a disease that causes your body’s immune system to attack your organs and tissues. Cognitive symptoms vary, but about 50 percent of people with lupus experience problems with memory, confusion, or trouble concentrating.

4. Depression and Anxiety

Depression, anxiety, and long-term stress can cause brain fog. Those experiencing depression may have difficulty thinking through problems or remembering things. Under chronic stress, our bodies flood our systems with hormones that keep our nervous system on high alert. And this can negatively affect all of our organs, including our brain.

Also, when we’re constantly operating in survival (“fight or flight”) mode, we have a hard time thinking clearly about anything. This is because our prefrontal cortex, the part of the brain responsible for logical, rational thinking, steps aside allowing more instinctually-driven parts to take over.

5. Long COVID

Many who have recovered from the COVID-19 virus report experiencing new or lingering symptoms months after they first became infected. "Long COVID," as it’s called, is also referred to as "COVID-19 syndrome (PACS)” or “post-acute sequelae of SARS-CoV-2 infection (PASC)” and can leave people with ongoing breathing problems, heart issues, digestive problems, sleep disruption, muscle pain, and mood changes.

Research has also found that some survivors of the COVID-19 virus show deficits in memory, visual search tasks, and cognitive reasoning. Because COVID-19 causes inflammation of the brain, clinicians believe this can impact the way neurons communicate. In the most serious cases, researchers claim that cognitive performance for those with long COVID is equivalent to a 7-point IQ drop.

How to Reduce Brain Fog

Current treatments available do not cure the symptoms of chronic brain fog, though many do improve cognitive skills and make symptoms easier to manage. Following are the most common pharmacological and non-pharmacological treatments for reducing brain fog:

Pharmacological. Although most current and common medications prescribed for depression do not seem to improve brain fog symptoms, serotonin-norepinephrine reuptake inhibitors (SNRIs) generally appear to be more effective than selective serotonin reuptake inhibitors (SSRIs).

In addition, a medication used to treat narcolepsy, modafinil (Provigil), may also treat cognitive symptoms. This wakefulness-promoting medicine acts on noradrenaline and dopamine in the body. One 2017 study found that taking 200 milligrams per day improved memory in people whose cognitive symptoms had not improved improve with the improvement of their depression.

Nonpharmacological. Certain psychotherapeutic approaches, such as cognitive behavioral therapy, (CBT) may help reduce chronic brain fog symptoms. These therapies can help patients cope with symptoms and gain a healthy perspective. Further, therapies that focus on strengthening cognitive functioning, including cognitive remediation and neurorehabilitation programs, can also help. We know is that the brain is plastic, so by practicing exercises that focus and stretch the mind, we often see amazing results.

Finally, some patients have found improvements in brain fog symptoms with some home remedies and lifestyle changes. These include:

  • Reading.
  • Avoiding common distractions.
  • Establishing a strong support system.
  • Stress-reducing practices, such as meditation and yoga.
  • Learning personal limits and respecting them to avoid feelings of burnout.
  • Using reminders, including diaries, calendars, Post-it notes, cell phone alerts, and lists.
  • Learning when cognitive skills are sharpest and completing important tasks during those times.
  • Keeping a food log and paying attention to whether eating certain foods has an effect on cognitive function.
  • Playing mind strengthening games, such as word or matching games, puzzles, and crosswords.

Experiencing cognitive impairment can be scary. It’s especially disturbing if you aren’t sure of the cause and the symptoms seem to be sticking around. If you experience any of the symptoms above, the best idea is to contact your healthcare provider and get evaluated.

The right clinician can help you learn how to reduce, cope with, and manage your brain fog.

There is hope.

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Gonda, X., Pompili, M., Serafini, G. et al. The role of cognitive dysfunction in the symptoms and remission from depression. Annals of General Psychiatry 14, 27 (2015).

Kaser, M., Deakin, J.B., Michael, A., Cormack, F., Rowe, J.B., Sahakian, B.J. Modafinil Improves Episodic Memory and Working Memory Cognition in Patients With Remitted Depression: A Double-Blind, Randomized, Placebo-Controlled Study. Biological Psychiatry CNNI 2, 2 (2017).

Perini, G., Cotta Ramusino, M., Sinforiani, E., Bernini S., Petrachi R., and Costa A. Cognitive impairment in depression: recent advances and novel treatments. Neuropsychiatric Disease and Treatment 15 (2019).

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