Brain Fog or ADHD? Understanding the Causes and Treatments*

When ADHD Isn’t the Answer: A Case Study

Lisa**, a 57-year-old marketing executive, sat in my office convinced she had adult ADHD. Over the past nine years, she had noticed a slow but steady decline in her ability to focus. Emails that once took minutes to write now felt like a struggle. She frequently lost her train of thought mid-conversation and felt mentally exhausted by the end of the day. At first, she assumed it was just stress or overwork, but as time went on, she began to wonder if she had been living with undiagnosed ADHD all along.

But something didn’t add up. ADHD symptoms typically emerge in childhood, and Lisa had no history of attention difficulties when she was younger. Instead, her cognitive challenges had developed gradually in her late 40s, which pointed to another explanation.

Through a comprehensive evaluation, we determined that her brain fog wasn’t ADHD—it was related to perimenopause and menopause. The fluctuating estrogen levels during this stage of life can impact neurotransmitters like dopamine and acetylcholine, both of which play critical roles in focus, memory, and mental clarity. Lisa was referred to her OB/GYN, and after starting hormone replacement therapy (HRT), her symptoms dramatically improved. Within months, she felt sharper, more focused, and more like herself again.

Lisa’s case is a reminder that brain fog has many causes, and the right treatment depends on identifying the underlying issue.

What Is Brain Fog?

Brain fog isn’t a medical diagnosis but a collection of cognitive symptoms that make thinking feel sluggish and unclear. People experiencing brain fog often report difficulty concentrating or staying focused, forgetfulness and trouble recalling information, mental fatigue even with simple tasks, slowed thinking and difficulty processing information, and struggles with word-finding or keeping up with conversations.

Brain fog can be temporary, triggered by stress or lack of sleep, or it can be persistent, caused by underlying medical conditions. Neurologically, it is often linked to neurotransmitter imbalances, inflammation, or disruptions in brain energy metabolism.

Is Brain Fog Psychological, Neurological, or a Cultural Phenomenon?

The answer isn’t simple—brain fog sits at the intersection of biology, psychology, and lifestyle.

Neurologically, it is often associated with dopamine and acetylcholine dysfunction, immune system overactivation, or hormonal fluctuations. It’s commonly seen in ADHD, long Covid, menopause, and thyroid disorders.

Psychologically, chronic stress, anxiety, and depression can lead to cognitive sluggishness. Elevated cortisol levels, a stress hormone, can impair memory, concentration, and executive function.

Culturally, our modern way of living—constant digital distractions, excessive multitasking, and mental burnout—can contribute to cognitive fatigue. Brain fog isn’t new, but the rise of information overload has made it more apparent.

Understanding which of these factors is at play is key to choosing the right treatment.

Brain Fog vs. ADHD: How to Tell the Difference

Many people mistake brain fog for adult ADHD, but while there are overlaps, there are also distinct differences.

ADHD is a lifelong neurodevelopmental condition, meaning symptoms like inattention, impulsivity, and distractibility typically appear in childhood. Brain fog, on the other hand, often develops later in life and fluctuates depending on external factors like stress, sleep, or hormonal changes.

For instance, someone with ADHD will likely struggle with focus even when they are well-rested and stress-free. In contrast, someone with hormone-related brain fog might feel mentally sharp on some days and completely unfocused on others.

If brain fog is persistent, seeking an evaluation from a psychiatrist who specializes in both ADHD and medical conditions can provide clarity.

Medical Treatments for Brain Fog

Since brain fog is a symptom rather than a condition, treatment depends on the root cause.

ADHD-related Brain Fog

ADHD-related brain fog is often due to dopamine and norepinephrine dysregulation. Stimulant medications like Adderall, Ritalin, or Vyvanse can improve focus and clarity. Non-stimulant options, such as Strattera or Guanfacine, may also be effective. Cognitive behavioral therapy (CBT) and structured productivity strategies help improve executive function.

Medical Causes

Long Covid or post-viral brain fog remains an area of ongoing research. The exact cause is still unclear, though some hypotheses suggest it involves neuroinflammation and immune dysfunction. While no proven treatments exist yet, some investigational approaches include N-Acetylcysteine (NAC), an antioxidant that may help reduce neuroinflammation, Low-Dose Naltrexone (LDN), a medication being studied for its effects on immune function and brain fog, and Modafinil (Provigil), which is sometimes used to counteract fatigue-related cognitive dysfunction. None of these treatments are FDA-approved for brain fog, and further research is needed.

Hormonal imbalances can also lead to cognitive issues. For women experiencing perimenopause or menopause, hormone replacement therapy (HRT) can help alleviate cognitive symptoms caused by fluctuating estrogen levels. Low testosterone in men can contribute to brain fog, and testosterone therapy may help in some cases. Thyroid dysfunction can impact cognition, and in such cases, Synthroid (T4) or Cytomel (T3) may be needed.

Sleep deprivation is one of the most common causes of brain fog. The first-line treatment for insomnia is Cognitive Behavioral Therapy for Insomnia (CBT-I), a research-based, highly effective approach. When necessary, short-term medications can be used, but long-term use is not well-supported by research. However, many patients require extended treatment, and risks and benefits should be discussed with a doctor. Treatment options include melatonin or magnesium for sleep support, short-term sleep aids like trazodone or eszopiclone (Lunesta) when appropriate, and CPAP therapy for sleep apnea, which can significantly enhance focus and cognitive function.

Causes That Need More Research

Nutrient deficiencies can also contribute to brain fog. Deficiencies in vitamin B12, iron, and omega-3 fatty acids can impair cognition, and supplementation may help. Some research suggests that Metformin, used for insulin resistance, and mitochondrial support supplements like CoQ10 and Acetyl-L-Carnitine could improve cognitive function in chronic fatigue-related brain fog, but these treatments are not FDA-approved and require further research.

Non-Medical Strategies to Improve Mental Clarity

Regardless of the cause, lifestyle changes can help. Prioritizing sleep by aiming for seven to nine hours of restorative sleep can significantly impact mental clarity. Eating a brain-boosting diet, such as the Mediterranean diet, which is rich in omega-3s, antioxidants, and healthy fats, supports cognitive function. Regular physical activity increases blood flow to the brain and boosts neurotransmitter levels. Reducing digital overload by limiting screen time and multitasking can help minimize cognitive fatigue. Managing stress through meditation, breathwork, and structured relaxation can improve mental clarity and focus.

Final Thoughts: When to Seek Help

If brain fog is persistent and affecting daily life, a medical or psychiatric evaluation can help determine if it’s ADHD, hormonal imbalances, post-viral inflammation, or metabolic dysfunction—each requiring a different approach.

Working with a psychiatrist who specializes in both cognitive and medical factors can lead to the right diagnosis and treatment plan.

For more insights on brain fog, ADHD, and optimizing cognitive performance, visit www.scottshapiromd.com.

*Disclaimer:

*This article is solely for educational purposes and not medical advice. You should contact your doctor or other healthcare provider to discuss the underlying cause of your symptoms and possible treatments.

**Lisa is a fictional character and case study—none of the symptoms reflect in any way an actual patient. This is to protect patient confidentiality.