Depression & Anxiety · Neurodiversity Resources

When mood or anxiety cloud thinking

Struggling with depression, anxiety, or PTSD can affect your ability to concentrate, think quickly, and remember things—especially in the midst of everyday demands and distractions. These struggles are real. When mood or anxiety is the primary cause, symptoms often improve with appropriate treatment. A neuropsychological evaluation can help clarify what’s contributing to your difficulties and guides you toward effective interventions.

Struggling with Depression

Depression is more than just feeling sad or going through a rough patch. It’s a persistent state that affects how you feel, think, and function in daily life. People with depression often describe feeling empty, hopeless, or numb rather than overtly sad. You might lose interest or pleasure in activities you used to enjoy, even things that previously brought you great joy. Energy levels plummet, making even simple tasks feel exhausting. Sleep changes are common—some people sleep far more than usual while others struggle with insomnia or wake frequently during the night.

Appetite and weight often change, either increasing or decreasing significantly. You might feel worthless or excessively guilty about things that aren’t your fault. Physical symptoms like headaches, body aches, or digestive problems can appear without clear medical cause. Some people experience psychomotor changes—either feeling physically slowed down and sluggish, or agitated and unable to sit still. In severe cases, thoughts of death or suicide may emerge.

Depression doesn’t look the same for everyone. Some people recognize they’re depressed, while others notice only physical symptoms or irritability. Depression can be mild and manageable, or severe and debilitating. It can come on gradually or appear suddenly, last weeks or persist for years.

How Depression Impacts Cognition

Depression affects thinking in ways that can be just as disabling as the emotional symptoms:

Concentration difficulties: Reading the same page multiple times without absorbing it, losing track of conversations mid-sentence, mind wandering, staying focused requires tremendous effort.
Slowed mental processing: Thinking feels effortful and sluggish. Making decisions, even simple ones like what to eat or wear, becomes overwhelming. Taking much longer to respond in conversations or complete tasks that used to be automatic.
Memory problems: Particularly for recent events and new information—forgetting appointments, conversations, or where things were placed. Walking into a room and forgetting why, struggling to recall what happened yesterday. Long-term memories typically remain intact, but forming new memories feels harder.
Mental fatigue: Cognitive tasks exhaust quickly after short periods. Mental stamina is reduced.
Executive function difficulties: Planning, organizing, initiating tasks, and following through on multi-step activities all become more difficult. Getting started on anything feels overwhelming. Complex tasks that require holding multiple pieces of information in mind or switching between different steps feel impossible.
Negative thinking patterns consuming mental resources: Rumination—repeatedly going over negative thoughts or past events—takes up cognitive bandwidth that would otherwise be available for concentration and memory.

It’s important to understand that these cognitive effects don’t mean something is structurally wrong with the brain. Depression affects how efficiently the brain functions, but the underlying capacity is typically intact.

Struggling with Anxiety

Anxiety involves persistent and excessive worry that’s difficult to control. While everyone experiences anxiety sometimes, anxiety disorders involve worry that is out of proportion to the situation, occurs frequently, and interferes with daily functioning. The worry might focus on specific things—health, work, finances, relationships—or feel more generalized and free-floating.

Physical symptoms often accompany the worry: muscle tension, restlessness, feeling keyed up or on edge, fatigue, irritability. Your heart might race, you might experience shortness of breath, sweating, trembling, or gastrointestinal distress. Some people develop panic attacks—sudden surges of intense fear with physical symptoms like chest pain, dizziness, or feeling like you’re losing control or dying.

Anxiety can also show up as avoidance. You might avoid situations that trigger anxiety, which can increasingly limit your life. Social anxiety involves intense fear of social situations and being negatively evaluated. Specific phobias cause overwhelming fear of particular objects or situations. Obsessive-compulsive disorder involves intrusive thoughts and repetitive behaviors aimed at reducing anxiety.

Like depression, anxiety exists on a spectrum from mild to severe and can be episodic or chronic.

How Anxiety Impacts Cognition

Anxiety significantly interferes with concentration and attention:

Difficulty with concentration and attention: The mind constantly scans for threats or potential problems, pulling attention away from the task at hand.
Worry consuming mental bandwidth: When preoccupied with anxious thoughts, less cognitive capacity remains for other tasks.
Mental interference from intrusive thoughts: The mind repeatedly returns to the same worries, interrupting the ability to think about anything else.
Feeling overwhelmed and mentally overloaded: Even when actual cognitive demands aren’t objectively overwhelming, everything can feel like too much.
Hypervigilance: Constantly being on alert for potential threats is mentally exhausting and leaves less energy for other cognitive functions.
Physical arousal symptoms are distracting: Racing heart, muscle tension, or restlessness make it harder to think clearly.
Sleep disruption: Difficulty falling asleep due to racing thoughts, or waking during the night with anxiety, leads to fatigue, poor concentration, and memory problems the following day.
Avoidance leading to worsening cognitive problems over time: Avoiding cognitively demanding situations because they trigger anxiety means not practicing those skills, which can make them feel even harder when unavoidable.

Like with depression, these cognitive effects don’t indicate structural brain damage. Anxiety interferes with the ability to use intact cognitive capacities effectively.

Struggling with Post-Traumatic Stress

Post-traumatic stress disorder (PTSD) can develop after experiencing or witnessing a traumatic event—something that involved actual or threatened death, serious injury, or sexual violence. Not everyone who experiences trauma develops PTSD, but for those who do, the disorder involves a constellation of symptoms that persist beyond the immediate aftermath of the trauma:

Intrusive symptoms: Unwanted, distressing memories of the trauma; nightmares; flashbacks; intense reactions to reminders.
Avoidance: Avoiding thoughts, feelings, people, places, or situations that serve as reminders, which can significantly limit activities.
Negative changes in thoughts and mood: Persistent negative beliefs, distorted blame, diminished interest, feeling detached, or unable to experience positive emotions.
Hyperarousal and reactivity: Irritability, hypervigilance, exaggerated startle response, sleep disturbance, difficulty concentrating, and being on guard.

How PTSD Impacts Cognition

PTSD affects cognition through multiple mechanisms:

Intrusive memories and flashbacks interrupt concentration and attention.
Hypervigilance consumes cognitive resources, leaving less capacity for other tasks.
Emotional numbing and detachment reduce engagement with cognitive tasks, making it harder to focus and encode new memories.
Sleep disturbance leads to fatigue and reduced cognitive efficiency.
Dissociation (feeling detached or experiencing gaps in memory) significantly interferes with attention, memory, and sense of continuity.
Constant physiological arousal is mentally exhausting and makes it harder to think clearly.

In addition to difficulties with attention and concentration, these problems can also yield executive functioning difficulties (e.g., problems with planning, organizing, and decision-making) and problems of overgeneralized memory (i.e., making new memories by remembering the gist of what happened but struggling to recall specific details or context).

Like depression and anxiety, these cognitive effects reflect how trauma and chronic stress affect brain function rather than structural damage. With appropriate trauma treatment, cognitive functioning often improves.

Why Seek an Evaluation?

You might consider a neuropsychological evaluation if:

You’re being treated for a mood or anxiety disorder but cognitive symptoms persist or worsen despite treatment.
You’re wondering whether cognitive difficulties might reflect neurodivergence (like ADHD or autism), a past concussion or head injury, or early signs of cognitive decline rather than mood or anxiety alone.
Family members have noticed changes in your thinking or memory that seem beyond what mood alone would explain.

How the Evaluation Process Works

Comprehensive assessment includes several components:

Clinical interview: Explores cognitive concerns, symptoms of depression and anxiety, trauma history, how symptoms developed over time, current life stressors, sleep patterns, medications, substance use, medical history, and family history of mood or cognitive disorders.
Mood and anxiety screening: Validated questionnaires to assess severity of depression, anxiety, PTSD symptoms, and other emotional factors.
Cognitive testing: Objective data on memory, attention, processing speed, executive functions, language, and visual-spatial skills—showing what you can do and how you approach tasks, and whether the pattern fits emotional interference or other causes.
Effort and validity assessment: Ensures results accurately reflect your abilities and aren’t unduly affected by extreme anxiety during testing, pain, or fatigue.

The evaluation looks at the whole picture: how symptoms developed, what makes them better or worse, how they affect daily life, and whether the pattern on testing is consistent with mood and anxiety effects.

Treatment and Interventions

When evaluation reveals that depression, anxiety, or PTSD are significantly contributing to cognitive difficulties, treatment focuses on addressing these underlying conditions. As emotional symptoms improve, cognitive functioning often improves as well.

Psychotherapy is often first-line. Cognitive-behavioral therapy (CBT) has strong evidence for depression and anxiety. For PTSD, trauma-focused therapies like Prolonged Exposure (PE) or Cognitive Processing Therapy (CPT) are particularly effective. Mindfulness-based approaches such as Acceptance and Commitment Therapy (ACT) and compassion-focused therapy can also help by building awareness of thoughts and emotions, living in the present, and cultivating self-acceptance.
Medications can be helpful for managing depression, anxiety, and PTSD symptoms (e.g., SSRIs, SNRIs). Discuss options with your primary care physician or psychiatrist to evaluate what’s appropriate.
Sleep intervention may be crucial, as poor sleep both results from and worsens mood, anxiety, and cognitive symptoms. Addressing insomnia and nightmares—through CBT-I or trauma-focused treatment for nightmares—can significantly improve both emotional and cognitive functioning.

It’s important to remember that cognitive difficulties related to depression, anxiety, and PTSD are typically reversible. These conditions affect how efficiently the brain functions, not its underlying capacity. With appropriate treatment, many people experience significant improvement in both their emotional symptoms and their cognitive functioning. The memory problems, concentration difficulties, and mental fog that feel so distressing don’t represent permanent damage—they reflect the temporary impact of treatable conditions. Recovery takes time, but improvement is possible.