Clinician handoff
Depression
Designed for a 60-second scan in primary care. Use this to explain why this theory fits, what would weaken it, and which tests are most worth discussing.
Why this still fits
I've had persistent low mood and brain fog for [DURATION]. My PHQ-9 score is [X]. I'd like to rule out medical causes before assuming primary depression.
What would weaken it
- -No low mood, loss of interest, emotional blunting, or morning-heavier mood pattern traveling with the fog.
- -The cognitive decline is clearly tied to thyroid disease, sleep apnea, meds, or another medical cause instead.
- -The fog changes dramatically with posture, meals, or infections in ways depression usually doesn't.
Key points to communicate
- •I want to separate true depression fog from thyroid, sleep, medication, and post-viral lookalikes.
- •Please tell me whether the cognitive symptoms fit depression itself or a different cause that's dragging mood down too.
- •If depression remains likely, I want to discuss treatments that address the thinking problems, not only the mood piece.
- •If I'm already on an antidepressant, can we review whether it has anticholinergic properties that might be making my fog worse?
Bring this to the visit
- •A completed PHQ-9 with the date.
- •A timeline of mood changes, sleep changes, and cognitive symptoms - which came first?
- •Current medication list with any recent changes to antidepressants or other psychotropics.
- •A note about functional impact: work performance, social withdrawal, self-care changes.
Useful screening structure
- -PHQ-9 as the standard depression severity measure.
- -MoCA if cognitive impairment seems disproportionate to mood symptoms.
- -TSH and ferritin to rule out medical mimics before attributing everything to depression.
Tests and measurements to discuss
Thyroid panel (TSH, Free T4)
What this helps clarify: This panel helps frame whether the story fits thyroid slowdown, conversion issues, or a closer competitor cause before you default to broad lifestyle explanations.
Range context
Panel context
How to use the result
Ask which thyroid number best fits the way your fog shows up day to day.
Ferritin, B12, Vitamin D
What this helps clarify: Severe deficiency doubles dementia risk
Range context
40–60 ng/mL
How to use the result
Save the result with date and symptoms from the same week.
hs-CRP
What this helps clarify: High-sensitivity inflammatory marker relevant to systemic and neuroinflammatory burden.
Range context
<1.0 mg/L
How to use the result
Save the result with date and symptoms from the same week.
Depression + Subtyping Panel
Sleep study (polysomnography or home sleep test) - if snoring, unrefreshing sleep, or daytime sleepiness
What this helps clarify: Gold standard for sleep apnea diagnosis
Range context
AHI <5
How to use the result
Ask for AHI, oxygen nadir, arousal index, and REM-specific findings.
Questions to ask directly
- •Is the fog from depression itself, from my antidepressant, or from a co-occurring cause?
- •If my medication might be contributing, are there cognitive-sparing alternatives?
- •Should we check thyroid, iron, B12, and vitamin D before adjusting my antidepressant?
- •Would adding cognitive behavioral therapy specifically targeting the fog pattern help?
Functional impact snapshot
- -Rate cognitive function on better mood days vs worse mood days - do they track together?
- -Track whether medication timing or dose changes shift the fog pattern.
- -Note which cognitive domains are worst: motivation, concentration, memory, or processing speed.
Escalate instead of self-managing if
- •Suicidal ideation, self-harm, or a plan - immediate safety assessment needed.
- •Psychotic features: hallucinations, delusions, or severe disorganization.
- •Cognitive decline that's progressive and doesn't fluctuate with mood - consider neurodegenerative workup.
Peer-reviewed references