16-year-old boy with Lyme disease presenting as depression
David, a 16-year-old boy, was initially presumed to suffer from long-standing depression. He exhibited anger, frustration, insomnia, poor appetite, mild weight loss, and passive suicidal ideation. David presented with “long-standing depression, exacerbated recently when he stopped dating a girl after only two weeks because he felt too tired and not smart enough,” according to Fallon and colleagues.  “He reported feeling spaced out all the time, as if in a fog.”
by Daniel J. Cameron, MD MPH
David’s steep decline in cognitive behavior and IQ and his onset of pain were initially presumed to be caused by “either laziness or mild depression.”
• He quit sports.
• His grades declined from A and A- in 7th grade to nearly failing by 10th grade.
• He appeared lazy because he found it hard to get out of bed in the morning.
• He often forgot to hand in assignments that he had in fact completed.
• He reported trouble staying awake in class and trouble concentrating.
• severe headaches
• facial fasciculations, myalgias
• stiff neck
• episodic paresthesias of his face and hands
• sudden sweating
• painful joints
• sore throats
• electric shock-like pains
• word-finding problems, such that it was hard to finish sentences
• semantic paraphasias
• short-term memory problems, such that he could not recall conversations
• testicular pain
Lyme disease was clinically diagnosed “given the suspicious clinical history.” His findings were:
• embedded tick bites
• absence of an erythema migrans rash
• a negative Lyme ELISA
• absence of another diagnosis
• significant deficits in processing speed and visual spatial memory
• 85% premorbid intellectual capacity
• an abnormal SPECT consistent with encephalitis, vasculitis, or Lyme disease
David was diagnosed with probable Lyme encephalopathy and treated with excellent results with 12 weeks of intravenous ceftriaxone. He improved on sleep, appetite, headaches, joint pains, numbness, distractibility, short-term memory, and emotional behavior. His depression cleared without the need for antidepressant medications. His IQ improved by 22 points, and his school performance markedly improved.
- Fallon BA, Kochevar JM, Gaito A, Nields JA. The underdiagnosis of neuropsychiatric Lyme disease in children and adults. Psychiatr Clin North Am. 1998;21(3):693-703, viii.