Bipolar Brain Fog and Thinking Changes

Bipolar symptoms differ from person to person and can be confusing for both the person experiencing them and those around them. Aside from severe mood swings, many with a bipolar mood disorder report that they experience a kind of “brain fog”. This brain fog can make everyday thinking feel unclear, slow and/or disorganised. The result is that oscillations between extreme highs (manic episodes) and then deep despair (depressive periods) can be made more difficult due to fuzzy and imprecise thought patterns.

Research indicates that this “brain fog” is far from psychosomatic. Instead, it’s rooted in very real brain activities, which can be monitored by sophisticated brain-scanning techniques. This discovery could have a significant effect on the way in which the disorder is diagnosed and treated. Additionally, the insight could help those suffering from bipolar disorder to better understand their probable need for treatment. 

What is Brain Fog in Bipolar Disorder?

Brain fog in bipolar disorder refers to cognitive symptoms that impact someone’s mental clarity, concentration and memory. Often, people who experience brain fog say that they feel mentally slow, unable to organise their thoughts and battle to focus. 

5 Common Symptoms of Bipolar Mental Fog

1. Slowed thinking or processing.
2. Difficulty concentrating.
3. Confusion during mood episodes.
4. Struggle following conversations.
5. Reduced mental sharpness and alertness.

How Bipolar Disorder Can Affect the Brain

More and more scientists are studying how bipolar disorder affects brain function. As a result, cognitive impairment is increasingly recognised as a core feature of bipolar disorder impacting attention, memory and executive function. 

Common Bipolar Disorder Cognitive Symptoms

• Difficulty concentrating.
• Mental “fog” or slowed thinking.
• Challenges with memory recall.
• Trouble organising thoughts.
• Reduced mental clarity during mood episodes.

Researchers from the University of Michigan Medical School and Depression Centre conducted brain monitoring tests to better understand bipolar symptoms. These tests required brain scans and periods of sustained cognitive concentration by the subjects. A large sampling of people with either major depression or bipolar disorder participated. The results were then compared with those in a sample (control) group which had no diagnosed mental conditions. There was a marked difference in the brain functionality between the two groups. 

The depression and bipolar group showed different levels of activity in their right posterior parietal cortex than those in the control group. This region of the brain is responsible for executive function. Which is responsible for activities such as working memory, problem-solving and reasoning. Those with depression showed higher activity, while those with bipolar disorder registered less brain activity. 

Dr Kelly Ryan, lead author of the study, reports that those with mood disorders have a shared cognitive dysfunction. This was pronounced in the cognitive control tests and more nuanced in scans. Dr Scott Langnecker, senior study author, adds that mental diseases thus have more overlap in the basic brain and generic signatures than previously assumed. 

Brain Functions Commonly Affected by Mental Illness

• Executive function.
• Working memory.
• Problem-solving ability.
• Attention and concentration capacity.
• Reasoning processes.

The researchers hope that their findings could influence clinical screening, diagnosis and treatment strategies of mood disorders, such as bipolar. 

How a Person with Bipolar Disorder Might Think During Different Episodes

Mental health conditions not only impact your feelings but also affect how you think and your cognitive capacity. Consequently, bipolar disorders change thinking patterns as well as shifts in moods. This means that each type of bipolar episode can change how a person thinks, processes information and makes decisions. A complicating factor is that these changes vary in severity from episode to episode as well as how they manifest in individuals. 

The effect on thinking depends on the type of bipolar episode being experienced.

During Mania or Hypomania

During a manic or hypomanic episode, a person’s thinking can become faster, their thoughts more scattered and/or they battle to control their thinking. To begin with, this can result in increased productivity and creativity. However, it often spirals out of control and can disrupt daily functioning by, for example, impairing judgement. 

5 Common Cognitive Symptoms During Bipolar Mania and Hypomania Episodes

1. Racing thoughts.
2. Rapid idea generation.
3. Impulsive decision-making.
4. Difficulty focusing on one task.
5. Reduced ability to filter distractions.

During Depression

Often, when a person enters a depressive episode, it has the opposite effect of a manic episode on cognitive ability. Their cognitive processing can significantly slow down and be impeded.  

5 Common Cognitive Symptoms During Bipolar Depression Episodes

1. Slowed thinking.
2. Difficulty concentrating.
3. Trouble making decisions.
4. Memory problems.
5. Reduced mental energy.

Between Bipolar Episodes

The time between bipolar episodes is a neutral mood state. It is known as the interepisode interval or euthymia and is characterised by emotional stability. This is where someone’s mood does not meet the criteria for a manic, hypomanic or depressive episode. A challenge is that these periods can complicate and delay the correct diagnosis of a bipolar disorder. Furthermore, someone experiencing euthymia can feel like they’re in a calm before the next storm. The result of this is often constant and cautious vigilance. 

Between mood episodes, many people with bipolar disorder: 

• Regain clearer thinking. 
• Function effectively at work. 
• Can maintain relationships. 
• Follow treatment plans better. 
• Manage symptoms successfully. 

Notably, the period between bipolar episodes can result in a significant improvement across life for someone with a bipolar mood disorder. With careful, active management, these between-episode periods can be extended such that they create stability and time to recover from a manic, hypomanic or depressive episode.

Can Bipolar Disorder Cause Memory Loss?

Bipolar disorder impacts the prefrontal cortex (PFC), which is the part of the brain responsible for executive function. The PFC is responsible for activities such as working memory, problem-solving, decision-making and reasoning. 

Examples of memory issues associated with bipolar disorder 

• Working memory difficulties. 
• Trouble recalling information. 
• Slower information processing. 
• Difficulty organising thoughts. 

However, once diagnosed, there are treatment regimens which are known to be very successful at managing bipolar symptoms like memory loss. These interventions can allow someone to be highly functional, to the extent that most others won’t know they have it. 

What Triggers Brain Fog and Cognitive Symptoms?

Lifestyle and environmental factors can worsen cognitive symptoms for people who have bipolar disorder. How much of a trigger these factors are varies from person to person.  

Due to the disorder affecting brain function and its nerve cell communication, sufferers are more susceptible to emotional and physical stress. Bipolar stress triggers, substance abuse and even lack of sleep can be triggers of brain fog and cognitive symptoms as well as bipolar episodes. However, none are actually seen to be the cause, even when the result is potentially debilitating. 

5 Common Brain Fog and Cognitive Symptom Triggers:

1. Sleep disruption.
2. Stress.
3. Substance use.
4. Physical exhaustion.
5. Major life changes.

Sleep distruption is one of the most common triggers for bipolar mood episodes.

When to Seek Professional Support

A bipolar mood disorder impacts both mood and thinking in three different ways, which means diagnosis can be tricky. Accordingly, a specialist is usually required to correctly diagnose a bipolar mood disorder and formulate a long-term bipolar treatment plan.

It is advisable to seek professional intervention when:

• Mood swings disrupt daily life. 
• Thinking or concentration becomes difficult. 
• Depressive symptoms persist. 
• Manic behaviours become risky. 
• Work or home functioning declines. 

Bipolar disorder requires careful diagnosis by a qualified mental health professional.

A bipolar mood disorder is a lifelong illness. However, with professional, consistent and careful management, this mental illness does not have to derail life. Effectively, having a correct bipolar diagnosis is the start of being able to lead a more stable, happier and successful life. 

A bipolar diagnosis evaluation typically includes a mental health assessment, reviewing family history and a physical exam, which might include lab tests. You might also be asked to keep a record of sleep patterns and moods. All of this information will be used to correctly diagnose and then formulate an individualised bipolar treatment plan. 

Treatment and Support That Can Help

The most effective treatment for bipolar has been shown to be one that combines medication with psychotherapy. Additionally, there are also certain lifestyle choices which can successfully supplement bipolar treatments, thereby increasing the efficacy of treatments.  

5 Examples of Support Strategies that can Help Manage Bipolar

1. Following a stabilising treatment plan. 
2. Psychotherapy or counselling. 
3. Maintaining consistent sleep routines. 
4. Engaging in creative therapeutic activities like gardening or art. 
5. Building supportive daily habits like following a balanced diet and regular exercise. 

Bipolar symptoms are manageable with the right treatment interventions.

Information about and understanding of bipolar disorder are key to assisting those who suffer from it and their support networks. Therefore, studies and awareness resources which provide insight into mental disorders such as bipolar are particularly helpful to read. 

Are you interested in helping people living with mood disorders? If so, explore SACAP’s Applied Psychology study pathways. SACAP (The South African College of Applied Psychology) offers rigorous training in areas of psychology through its Applied Psychology Faculty. Contact a SACAP Admissions Officer for more information or enrol online.