Brain Fog & COVID-19

I’ve noticed a new concern from my patients since we’ve all been living with COVID-19. Specifically, they’re asking me about feeling such things as “brain fog” and they’re very worried. Is this really a thing? Individuals who previously have had no cognitive issues are now describing new or worsening experiences of, forgetfulness, feeling “like I’m in a daze”, lack of motivation, low energy, word-finding difficulties. The short answer to “is this a thing”, in my opinion, yes, and I will define it. As a psychiatrist, I want to emphasize how vitally important it is to tease out a clinical depression from this phenomenon as there are commonalities. This distinction is especially important because the former requires support from a mental health professional and the latter requires reassurance and a few simple interventions. 

To provide some very broad strokes, (consult with your own physician if you have concerns), clinical depression is typically manifested with a sad, persistent mood lasting several weeks, accompanied by other symptoms such as low energy, decreased interest, or inability to experience pleasurable activities in life, difficulties with sleep cycle, changes in appetite, to name but a few. One can see how this needs to be teased apart from this so-called “brain fog”. I am going to coin the name Covid Deprivation Syndrome (or CDS because we in the medical profession cannot help ourselves and are compelled to use acronyms) to describe this experience. Please note this is a clinical term I have coined, based on my practice, and has not been assessed through any kind of randomized control studies to be statistically meaningful.  

First, what exactly is what I’m calling Covid Deprivation Syndrome or CDS? It is exactly as my patients, always a wonderful, rich, source of information, have described. Using psychiatric jargon, it is a mildly dysphoric (uneasy/dissatisfied) state manifested with mild cognitive (means brain) impairments such as forgetfulness, word-finding difficulties, inattentiveness, or distractedness. It can be accompanied by an experience of disconnectedness and low energy and represents a change from an individual’s baseline functioning.

Next, what causes CDS? The name provides the answer. Social deprivation. We human beings are social creatures. We are wired for social interaction. As a forensic psychiatrist, I ask what is the worst punishment you can administer to a prisoner? How about answering the question as a parent? For a prisoner, the absolute worst thing you can do is put someone in lockdown. It is called “The Hole” for good reason; 24/7 by themselves, with no social interaction. That this is the worst punishment is a very powerful statement. Incidentally, what do we do as (really good) parents to discipline our children? We put our children in Time Outs. Well, our country, even the world, has been in social lockdown/Time Out for almost 1 ½ years due to the COVID-19 virus. Of course, this impacts our brain! Of course, people are complaining of cognitive issues.  

When we are socially interacting, our neurons are “socially” interacting. They are connecting with each other and form, rich, deep dendritic connections to strengthen these connections. And if this weren’t enough, what’s making it worse is the direct human social interaction with which it’s been replaced, is a computer. There are wonderful advantages to telecommuting, telehealth, particularly during a pandemic, but it cannot ever fully replace “tell a friend”, in person. The challenges of computer work include possibly losing some of our social skills. Sometimes we forget there are people not icons on the other sides of keyboards. We are also stuck in chairs, staring at screens for long periods of time. We are not moving our bodies and we are forgetting to nourish our souls.   

What is the cure for CDS? The cure for Covid Social Deprivation is social interaction. Social isolation is devastating to our brains. It is important that each individual assesses their own level of comfort and safety, their individual health risks, any external parameters, and determine best how to increase their socializing. We are designed and wired for this. The next, single best thing you can do is exercise. Move our bodies. It oxygenates our brains, wakes up the muscle fibers, and brings everything to life. It needn’t be drastic. Simple walks can start. Next, consider re-regulating your sleep/wake cycle. Sitting behind the computer, days turn into night and nights turn into days. Don’t forget to add pleasurable activity to life; truly, simple little things. Turn on the music and turn off the TV. Music not only soothes the savage beast, but it also heals the weary human. Start adding positive reading or positive audio to your life. We are what we consume. Metaphorically and otherwise.

COVID-19 has radically and negatively impacted all of our lives. Many people have developed cognitive symptoms in a syndrome I’ve termed Covid Social Deprivation.  While we have a long way to go, we have also come a long way. We can all reflect upon our own thought processes in March 2020 and compare how different we are now. We’ve found new and creative ways to manage life and we will continue to do so. Every one of us needs to assess our own comfort level in this new world, but however, we choose (even if your safety and health concerns keep you limited to more virtual settings) we are social creatures and thrive when we interact with one another. With all the negativity in the world, it’s vital that we consciously add positive input into our lives either through reading or audio and keep moving our bodies. We need to start reclaiming our humanity and re-engaging in positive ways with one another.

Renée S. Kohanski, M.D.

General & Forensic Psychiatry

Diplomate of the American Board of Psychiatry & Neurology