Psychiatric and Brain Fog
Guideline: NICE CG185 Bipolar; NICE CG178 Psychosis; NICE NG116 PTSD; NICE CG159 Social Anxiety
What Is Psychiatric-Related Brain Fog?
NOT ALL COGNITIVE SYMPTOMS ARE 'BRAIN FOG' — some are psychiatric emergencies. Bipolar disorder (manic/depressive episodes with cognitive impairment), psychotic disorders (hallucinations, delusions, thought disorder), PTSD (dissociation, concentration failure, hypervigilance), severe anxiety (cognitive paralysis, depersonalization), and OCD (intrusive thoughts consuming cognitive bandwidth) all cause profound cognitive dysfunction that requires PSYCHIATRIC treatment, not lifestyle optimization. If you are experiencing hallucinations, hearing voices, believing things others don't, severe dissociation, or thoughts of self-harm — seek psychiatric evaluation immediately.
What to Do This Week
Seven actionable steps you can start today — free, evidence-based, and designed for when you're foggy.
Body
If you're in crisis, contact emergency services (999/911/112) or Crisis Text Line (741741 US / 85258 UK). If you're stable: maintain sleep schedule and eat regular meals. These support neurotransmitter stability.
Food
Eat a proper meal with protein, vegetables, and good fat (olive oil, nuts, avocado). Skip the ultra-processed snack. One meal upgrade today.
Water
Drink a glass of water now. Keep a bottle visible. Aim for pale yellow urine. Don't overthink it — just drink regularly.
Environment
Open a window for 15 minutes. Fresh air exchange reduces indoor pollutants. If outdoors is bad (pollution, pollen), use a HEPA filter.
Connection
Tell someone how you're really feeling. If that's impossible right now: Crisis Text Line (text HOME to 741741 US / text SHOUT to 85258 UK). You are not a burden.
Tracking
Rate your brain fog 1-10 each morning for 7 days. Note sleep quality, food, exercise, stress. Patterns emerge within a week.
Avoid
Don't change everything at once. One new habit per week. Don't compare your progress to others. Don't spend money on supplements before nailing sleep, food, and movement.
What to Eat: The Steady Meals — No Fasting Approach
For conditions where blood sugar stability or regular energy intake is critical. Anti-crash eating.
Sample Day
- breakfast: Eggs + avocado + sourdough toast (within 1 hour of waking)
- midMorning: Greek yogurt + handful nuts
- lunch: Chicken + sweet potato + mixed salad + olive oil
- afternoon: Apple + cheese or nut butter
- dinner: Fish + rice + roasted vegetables
- preBed: Small handful almonds + banana (if needed)
For Psychiatric: Steady blood sugar supports neurotransmitter stability. Don't skip meals — hypoglycemia worsens anxiety and mood instability. Mediterranean pattern has evidence for depression. If appetite is suppressed by medication, small frequent meals. Avoid alcohol (interacts with most psychiatric medications).
This is about STABILITY, not restriction. Eat enough. If you have POTS, ME/CFS, or migraine, fasting is harmful, not healing. Ignore intermittent fasting trends if you crash.
When to Seek Urgent Help
🚨 EMERGENCY — Call emergency services (911/999/112) NOW if: active thoughts of suicide or self-harm, hearing voices telling you to harm yourself or others, severe confusion with agitation, not sleeping for 3+ days with escalating energy/grandiosity (mania), losing touch with reality. These are psychiatric emergencies. ⚠️ URGENT (see GP/psychiatrist within days): new hallucinations, severe dissociation, panic attacks preventing function, intrusive thoughts causing severe distress, rapid personality change noticed by others.
Tests and Investigations
Psychiatric Assessment
Medical Rule-Outs
Evidence-Based Lifestyle Changes
This is NOT a Lifestyle-First Cause for Acute Presentations
If you are actively experiencing psychotic symptoms, mania, severe dissociation, or suicidal thoughts — lifestyle changes are NOT your first step. Seek psychiatric evaluation. Lifestyle supports (sleep, exercise, social connection, routine) are important ALONGSIDE professional treatment, not instead of it.
Evidence: Strong — all NICE guidelines for bipolar, psychosis, PTSD recommend specialist-led treatment as first-line.
Sleep Regulation (Essential Foundation)
Fixed wake time. 7-9 hours. No all-nighters (sleep deprivation can trigger mania). Discuss sleep medication with psychiatrist if needed.
Evidence: Strong — sleep is a critical vital sign in psychiatric management.
Holistic Support
Morning sunlight
Strong — resets circadian clock, improves mood, supports vitamin D.
10-15 min outside within 1 hour of waking. No sunglasses needed.
Cyclic sighing breathwork
Strong — Balban Cell Rep Med 2023.
5 min daily. Double inhale nose, long exhale mouth.
Nature exposure
Moderate — cortisol reduction, attention restoration.
20 min in green space weekly minimum.
Medical Treatment Options
Discuss these options with your prescribing physician. This information is educational, not medical advice.
Condition-Specific Psychiatric Treatment
Bipolar: mood stabilizers (lithium, valproate, lamotrigine) ± atypical antipsychotics. Psychosis: antipsychotics (specialist-led). PTSD: trauma-focused CBT or EMDR (NICE first-line). Severe anxiety: SSRI + CBT. OCD: SSRI (high-dose) + ERP therapy.
Evidence: Strong — all guideline-directed.
Psychotherapy
CBT for most conditions. Trauma-focused CBT or EMDR for PTSD (NICE first-line, not medication). DBT for emotional dysregulation. ACT for chronic conditions. Family therapy for psychosis.
Evidence: Strong — NICE first-line for PTSD, anxiety, and OCD. Adjunct for bipolar and psychosis.
Supplements — What the Evidence Says
Supplements are adjuncts, not replacements for lifestyle changes. Discuss with your healthcare provider.
Note
Dose: N/A
This is a medical-first cause. Professional psychiatric care is the foundation. Supplements are potential adjuncts only.
Evidence: Low for primary treatment.
Psychological Support and Therapy
Condition-specific — see psychiatric cause entry. PTSD: trauma-focused CBT or EMDR (NICE first-line). Bipolar: psychoeducation + therapy alongside medication. Psychosis: early intervention service. OCD: ERP (Exposure and Response Prevention) + high-dose SSRI.
What People With Psychiatric Brain Fog Say
What Helped
- • Getting the RIGHT diagnosis — years of antidepressants for what was actually bipolar II. Mood stabilizer changed everything.
- • EMDR for PTSD — 8 sessions cleared a fog I'd had for 5 years since the trauma.
- • Reducing cognitive load during psychotic recovery — employers didn't understand that recovery from a psychotic episode takes months.
- • Stopping alcohol alongside psychiatric treatment — was self-medicating. Removing alcohol let the medication actually work.
What Didn't Help
- • Being told psychotic symptoms were 'spiritual awakening' or 'detox reactions' — delayed psychiatric treatment by months.
- • Supplement stacks for bipolar — no supplement replaces lithium for mood stabilization.
- • Meditation during active PTSD flashbacks — made dissociation WORSE. Trauma-focused therapy was needed first.
- • Pushing through cognitive symptoms without adjusting work/expectations during recovery.
Common Mistakes
- • Self-diagnosing from internet questionnaires and treating with supplements instead of seeking psychiatric evaluation
- • Stopping psychiatric medications because of side effects WITHOUT medical supervision (withdrawal is dangerous)
- • Attributing psychiatric symptoms to physical causes and spending years investigating everything else
- • Delaying PTSD treatment because 'it happened a long time ago' — PTSD doesn't have an expiration date
Surprises
- • That autoimmune encephalitis can present as psychiatric illness — anti-NMDA receptor encephalitis looks exactly like psychosis but is treatable with immunotherapy.
- • That bipolar II fog is different from bipolar I — the depressive phase cognitive impairment is often worse than the manic phase.
- • That PTSD causes concentration failure and memory problems even when 'not thinking about the trauma' — it's a brain-state, not just flashbacks.
- • That psychiatric medication cognitive side effects are common but often adjustable — don't just accept fog as the price of stability.
"If your brain fog comes with hallucinations, mood episodes, flashbacks, severe dissociation, or intrusive thoughts — this is not a supplement deficiency. This is a psychiatric condition that deserves proper professional care. Seeking help is not weakness; it's the most effective intervention that exists."
Quick Reference
Quick Win
Answer honestly: (1) Do you experience periods of extremely elevated mood/energy alternating with crashes? (2) Do you hear/see things others don't? (3) Do you have flashbacks or nightmares from a traumatic event? (4) Do you have intrusive thoughts you can't control? (5) Do you feel detached from reality or your own body? If YES to ANY — see your GP for psychiatric referral. This is not a supplement problem.
NICE psychiatric pathways