Distressed patient: “I don’t know, I can’t really explain it. I just don’t feel like my brain is working as well.”

Grumpy, new-doctor me: Internal, too-tired-sure-I-get-it eye roll and a "Hmmm... that sounds really difficult for you."

In residency, I had patients describe their brains like they were thinking through molasses. Or like they knew what they wanted to say, but couldn’t quite reach the words.

I nodded.

I empathized.

And after weeks on call with little sleep and too much coffee, I sort of got it.

But now? With this delightful peri-brain of mine? I REALLY get it.

That’s NOT the brain fog I’m talking about today though.

Brain fog isn’t always from stress, sleep deprivation, or hormonal changes.

It’s also a cognitive side effect of psych meds that doesn’t get nearly enough attention.

And when it sneaks up on clients, they can feel like they’re losing their edge.

But because it can be subtle, if they’re not paying attention to timing they may not realize it’s from medication!

There are plenty of medications that can cause brain fog or mental clouding but the big players I see in my clinic are from Buspar (busprione), Topamax (topiramate), and lithium.

This week’s short video is all about recognizing medication-related brain fog and what therapists can do to support clients when it shows up.

It’s just 6 minutes so I recommend a quick brain break to check it out, but here are the big takeaways in case you’re super short on time:

• What it is: Trouble focusing, slowed thinking, and memory hiccups usually starting shortly after a medication change.
• Where it comes from: Mood stabilizers, antipsychotics, and some antidepressants can disrupt cognitive speed, neurotransmitter balance, or sleep.
• What else it could be: ADHD, depression, or even medical issues like hypothyroidism, so timing and context are really important.
• What to do: Help clients identify and name it, use adaptive/supportive strategies, and talk with prescribers about adjustments.
• Why it matters: Clients usually feel pretty self-critical about this “slowness,” and your insight can help them feel seen and supported (and save them some serious negative self talk).

From my experience, this isn’t always an easy fix and usually I end up switching meds. I'll wait a few weeks if it’s brand new because sometimes the fog will dissipate, but if it’s been a month or someone is really feeling the negative impact, it’s time to try something else.

My hormonal brain fog, on the other hand, is not so quick to resolve! I’m just trying to embrace it as a gift for surviving this long.

And when it pops up inconveniently? I try to keep my sense of humor. I know a lot of big words (and small ones too!) so if I can’t think of one I’ll start with a curse word and then pop in something else that’s close enough. 😂

(Eh. It’s not perfect but that’s not really my goal.)

Now your clients won’t be wondering what’s wrong with their brains after their prescriber gave them something for anxiety that starts with a B. Reader saves the day! Again!

Cheers to healthy brains,

Dr. B

Jessica Beachkofsky, MD

Your friendly, online psychiatrist!

P.S. Here’s that video link, in case your brain feels foggy for any reason…

P.P.S. It’s time to start planning! The Aloha Summit is in mid-October and there’s a seat with your name on it! Island vibes, learning with the coolest people, yoga, connection, what’s not to love? But don’t take my word for it. Check out the details and see what you’ll be missing if you don’t get booked soon! We got to April in the blink of an eye! October here we come….