One study found a high prevalence of depression in Lyme disease patients. Between 2008 and 2014, one in five patients treated at the Lyme Center Apeldoorn in the Netherlands was diagnosed with depression and Lyme disease.

Dr. Robert Bransfield, a psychiatrist specializing in tick-borne illness, reports that depression is the most common psychiatric syndrome associated with late-stage Lyme disease. He estimates that at least 1,200 people per year commit suicide as a result of Lyme disease.

Borrelia burgdorferi may be diagnosed as a persistent infection with immune-suppressant and evasive capabilities, or there may be a post-infectious process. In either case, the psychiatric symptoms are associated with an immune-mediated process.

A 16-Year-Old Boy Whose Depression Was Lyme Disease

Brian Fallon, MD, director of the Lyme and Tick-Borne Diseases Research Center at Columbia University, describes the case of a 16-year-old adolescent who presented with long-standing depression that suddenly worsened.

He reported anger, frustration, insomnia, poor appetite, mild weight loss, and passive suicidal ideation. He would say, “I wish I could just die in my sleep.” He complained of brain fog and had a steep decline in cognitive abilities. His symptoms were initially presumed to be caused by either laziness or mild depression.

He suffered from ongoing knee pain and was forced to quit sports. His grades dropped from A’s in 7th grade to nearly failing by 10th grade. He suffered from fatigue and forgetfulness. He appeared lazy because he found it hard to get out of bed in the morning.

Symptoms Beyond Depression

The boy’s symptoms were extensive: severe headaches, facial fasciculations, myalgias, stiff neck, hyperacusis, episodic paresthesias of his face and hands, sudden sweating, painful joints, sore throats, palpitations, electric shock-like pains, word-finding problems, semantic paraphasias, and short-term memory problems so severe he could not recall conversations.

Since he reported having embedded ticks in the past, Lyme disease was clinically diagnosed given the suspicious clinical history. His Lyme ELISA results were negative twice in the prior three months, but his IgG Western blot revealed four of the five requisite CDC-specific bands. A brain SPECT revealed findings consistent with encephalitis, vasculitis, and Lyme disease.

Treatment Response

The boy was diagnosed with probable Lyme encephalopathy and treated 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.

Clinical Perspective

This case demonstrates that Lyme disease presenting as depression in a teenager can be profoundly disabling — and profoundly reversible when correctly diagnosed. A 22-point IQ improvement and resolution of depression without antidepressants are not outcomes that primary psychiatric treatment alone would have achieved.

When a young patient’s depression appears alongside cognitive decline, migratory pain, neurologic symptoms, and a history of tick exposure — and when ELISA testing is negative — clinicians should not stop investigating. Western blot and clinical evaluation may reveal what standard screening missed.

Frequently Asked Questions

Can Lyme disease present as depression in teenagers?
Yes. This case demonstrates that Lyme encephalopathy can produce depression, cognitive decline, academic failure, and suicidal ideation that closely mimic primary psychiatric illness.

Can Lyme disease affect IQ?
Yes. This patient’s IQ improved by 22 points after 12 weeks of IV antibiotic treatment, suggesting that cognitive impairment from Lyme encephalopathy can be reversible.

Can Lyme ELISA be negative when Lyme is present?
Yes. In this case, ELISA was negative twice while IgG Western blot was positive. A negative ELISA does not rule out Lyme disease.

What is Lyme encephalopathy?
Lyme encephalopathy is a form of neurologic Lyme disease affecting the brain, producing cognitive impairment, mood changes, and neuropsychiatric symptoms. Brain SPECT imaging may reveal findings consistent with encephalitis or vasculitis.

Did the depression require antidepressant medication?
No. In this case, depression resolved entirely with antibiotic treatment of the underlying Lyme infection, without antidepressant medication.

References

1. Zomer TP, et al. Depressive symptoms in patients referred to a tertiary Lyme center: high prevalence in those without evidence of Lyme borreliosis. Clin Infect Dis. 2017;65(10):1689–1694.
2. Bransfield RC. Suicide and Lyme and associated diseases. Neuropsychiatr Dis Treat. 2017;13:1575–1587.
3. 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.

Related Reading

• Psychiatric Lyme Disease: Misdiagnosed as Mental Illness
• Lyme Disease Depression: Not “Just Depression”
• Don’t Confuse Somatic Symptoms with Depression in Early Lyme Disease
• Lyme Disease: “You Need to See a Psychiatrist”
• Brain Fog and Lyme Disease
• Bartonella Psychiatric Symptoms: When Antibiotics Work Better