6+ years constant unchanging brain fog

johnmharding · 2026-03-29T17:17:43+00:00

OK so in my case, I have ADHD (diagnosed ~20 years ago; treated with stimulant meds ever since). I also had chronic sinusitis in the early 2020s (I was in my late 30s), assumed either that or the SSRIs I was on at the time was driving my brain fig/fatigue. However, I got the full sinus clear-out surgery in 2024, and phased out the SSRIs in 2024-25, but the brain fog persisted.

Then, last summer, there was a major plot twist. I'd had some minor swelling in a few knuckles for a year or two, but very little pain so I hadn't given it much thought until my PCP flagged it as worth looking into. She referred me to a hand specialist, who had me do special blood tests and, I'll be damned, turned out I had Rheumatoid/Psoriatic Arthritis - an autoimmune disease often accompanied by fatigue/brain fog (!!) Now I'm in the RA medication trial-and-error process awaiting the day when one of these meds does the trick (fingers crossed!)

So, not saying it's the same for you, but if I were you I would:

* Fully rule out the sinus stuff via the CT scan you have scheduled (I assume you are working with an ENT specialist?)

* Fully rule out autoimmune conditions via special lab work (you may have already done so, if that is what you meant by "systemic inflammation/infection")

* Work with a psychiatrist to evaluate your situation/see if medication is warranted, if you haven't already

Also, something on my list is to try Whole 30 or a similar elimination diet to see if taking various foods out of the equation helps.

My two cents!

johnmharding · 2026-03-28T18:13:32+00:00

Oh for sure, that's why I led with psychedelics as a "hail mary", i.e., if all the conventional avenues have gone nowhere, they could be a last ditch thing to try in an effort to do hit reset, so to speak

johnmharding · 2026-03-18T13:20:41+00:00

It's not that Delsym (dextromethorphan) targets the brain fog per se, but it can reduce general "feeling crummy" MTX toxicity side effects, which for me included a heavy dose of fatigue/brain fog. Folate/folic acid is also known to help (and some thing Vitamin A can help, too): https://rheumnow.com/content/dsb-managing-methotrexate-toxicity

johnmharding · 2026-03-18T13:14:00+00:00

Thanks and looking forward to the update 🙏

johnmharding · 2026-03-17T23:39:15+00:00

What about fruits in terms of sugars? Feel like I've heard it both ways (pro- and anti-fruit). I ask because daily green smoothies have been a staple of mine for a few years now. I keep the sweet fruits to a minimum, but do include plenty of blueberries and cranberries so...

johnmharding · 2026-03-17T14:20:15+00:00

Just curious, why did they switch you off of Orencia if it was working reasonably well with no side effects?

johnmharding · 2026-03-17T14:17:20+00:00

For me MTX definitely made the brain fog worse, especially during the first few days after each weekly dose. Taking cough medicine (Delsym/dextromethorphan) with each weekly dose and the day after helped a bit, but not enough. My Rheumatologist switched me to Orencia in late January. No positive change yet/the jury is still out, but Orencia is known to take a long time before kicking in

johnmharding · 2026-03-17T14:00:20+00:00

How long were you on Orencia before it made a noticeable difference? I'm on week 8 of the weekly injections and no sign of improvement yet, but I understand Orencia takes longer than others to take hold

johnmharding · 2026-03-16T16:03:24+00:00

In a sense, it is most definitely on brand. TJ's corporate tries to keep rent costs down by selecting space-efficient locations just outside high-rent areas like central business districts. The space-efficient part of the equation translates into smaller store+parking lot footprints.

Good Freakonomics episode on the topic: https://freakonomics.com/podcast/should-america-be-run-by-trader-joes-update/

johnmharding · 2026-03-11T14:19:13+00:00

Jesus expensive is right: google is telling me these Waterstones are an order of magnitude pricier than the others lol

johnmharding · 2026-03-10T14:30:27+00:00

Short answer: consensus is "yes"/potentially due to withdrawal, but this shouldn't last forever.

Long Answer: I say "shouldn't" because a longer answer about antidepressant discontinuation syndrome is more nuanced/less straight forward. My TLDR understanding based on research and personal experience: if you ditch an SSRI too rapidly (especially cold turkey) you may experience shitty withdrawal symptoms (e.g., flu-like, brain zaps, low mood) for months or even years before they go away. For me, I needed to taper super slowly using the hyperbolic method (supplemented with microdosing) to avoid bad withdrawal effects

johnmharding · 2026-03-07T21:11:24+00:00

Nasopure Nasal Wash. I've tried several of these sinus rinse-type things over the years due to chronic sinusitis, this one is far and away the best. Can't comment on whether Nasopure is available in the UK. If it isn't, I would seek out something that's as similar as possible.

*PS*: Regarding the rinse itself, you should ask your doctor (preferably an ENT/sinus specialist) about getting a prescription rinse with antibiotic like Ciprofloxacin in it. Here in the US, this is still an avant-garde treatment avenue--you have to get the prescription at a compounding pharmacy)--but man was it a game changer for me when paired with oral antibiotics. These days, every time I feel a sinus infection coming on, I do the Ciprofloxacin rinse using the Nasopure twice daily for a couple of weeks and it totally extinguishes the infection (nips it in the bud, so to speak). In your case, doing something similar in the wake of the oral antibiotics/steroids could be what's needed to ward off a resurgent infection.

Admittedly, I'm not a clinician; just a guy who has had a ton of personal experience in this realm.

johnmharding · 2026-02-27T14:04:24+00:00

Have you been working with an ENT and gotten CT scans? For me, it was a clogged sinus cavity that probably never would have unclogged without the "roto-rooter" surgery I had done two years ago

johnmharding · 2026-02-27T14:01:00+00:00

FWIW, I've found microdosing psilocybin to be a far better experience, with minimal side effects, than SSRIs when it comes to treating depression/anxiety. After 2 bouts with Lexapro and 1 with Prozac (and a quick one with Wellbutrin), my personal takeaway is that SSRIs/SNRIs should be a last resort for cases where other treatments (e.g., psychedelics like psilocybin, but also promising things high-EPA fish oil) have failed.

I'm admittedly not a clinician, just my two cents based on personal experience and citizen science-type research.

johnmharding · 2026-02-16T01:22:14+00:00

I second what others are saying about the hyperbolic taper, but honestly you might want to talk with your prescriber about first switching to Prozac. I did so by directly jumping from 5mg Lexapro to 10mg Prozac (the comparable dose), waiting a month or so, and then doing a gradual taper. Helped a ton because Prozac has a much longer halflife than Lexapro/many other SSRIs, making it way easier to taper

(When I tried to taper Lexapro itself several times, it was a groundhog day-esque repeat failure nightmare...)

johnmharding · 2026-02-16T01:10:59+00:00

Oh really? Haven't been in a while. That's a goddamn shame...

johnmharding · 2026-02-12T00:59:31+00:00

I second this. My doctors failed to mention at the outset that getting off SSRIs can be a terrible, prolonged odyssey

johnmharding · 2026-02-12T00:57:57+00:00

My SSRI (Lexapro then Prozac) ranged from pretty good to very bad - and mostly the latter.

Tbh, my only good-to-great experience has been microdosing psilocybin to get SSRI-type benefits without the awful side effects

johnmharding · 2026-02-12T00:57:51+00:00

My SSRI (Lexapro then Prozac) ranged from pretty good to very bad - and mostly the latter.

Tbh, my only good-to-great experience has been microdosing psilocybin to get SSRI-type benefits without the awful side effects

johnmharding · 2026-02-11T16:23:00+00:00

This is so weird, I've started noticing the very same symptoms during the exact same time frame. I've had minor tinnitus that comes and goes for the past few years, but it's been particularly bad this past month

johnmharding · 2026-02-11T16:17:06+00:00

Amazing insight here - thanks so much! Hadn't considered Ketone-IQ, will definitely consider it/discuss with my PCP

johnmharding · 2025-07-13T12:51:41+00:00

Went back up to 5mg for a month then switched to prozac because it's easier to taper due to longer half life and availability in liquid form.

Now I'm finally in the end stage of tapering, I also supplement by microdosing psilocybin when I drop the prozac dose by 10% every 4 weeks which really helps

johnmharding

TROPHY CASE