16-year-old boy with Lyme disease presenting as depression

Adolescent with Lyme disease and depression holding his head

There has been increasing research linking COVID-19 with the development of neuropsychiatric symptoms, including depression and anxiety. But multiple studies have already found an association between other infections, such as Lyme disease, and the onset of depression.

 

One study found a high prevalence of depression in Lyme disease patients. Between January 2008 and December 2014, 1 in 5 patients treated at the Lyme Center Apeldoorn in the Netherlands was diagnosed with depression and Lyme disease. ¹

Meanwhile, Dr. Robert Bransfield, a psychiatrist specializing in the diagnosis and treatment of tick-borne illnesses, reports “In my database, depression is the most common psychiatric syndrome associated with late-stage Lyme dis­ease.”

“I estimate that there are at least 1,200 people per year who commit suicide as the result of Lyme disease,”  Bransfield writes in his article “Suicide, Lyme and Associated Diseases.” ²

Borrelia burgdorferi, the causative agent of Lyme disease, “may be diagnosed as a persistent infection with immune suppressant and evasive capabilities or there may be a postinfectious process,” Bransfield writes. “In either case, the psychiatric symptoms are associated with an immune-mediated process.”

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, which suddenly worsened.³

Neuropsychiatric symptoms

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.”

The boy 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.

Depression can be a presenting symptom of Lyme disease. Click To Tweet

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,” Fallon writes.

The boy’s symptoms were extensive and included:

• 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, such that it was hard to finish sentences
• semantic paraphasias
• short-term memory problems, such that he could not recall conversations
• testicular pain

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 3 months, but his IgG Western blot revealed 4 of the 5 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.

References:
  1. Zomer, T.P., 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): p. 1689-1694.
  2. Bransfield RC. Suicide and Lyme and associated diseases. Neuropsychiatr Dis Treat. 2017;13:1575-1587. Published 2017 Jun 16. doi:10.2147/NDT.S136137.
  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, viii.
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3 Replies to "16-year-old boy with Lyme disease presenting as depression"

  • Donna Falcone
    08/06/2020 (10:06 am)
    Reply

    “His Lyme ELISA results were negative twice in the prior 3 months, but his IgG Western blot revealed 4 of the 5 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.”

    This is the most stunning piece of the whole story to me…. that any medical practitioner can deny the havoc Lyme can deliver to a young person’s (any person’s) life is inexcusable in the light of the actual RESULTS of persistent curiosity in light of THREE negative ELISA tests (most regular doctors stop at one, hand the patient an Rx for Xanax and send them home). The doctors working with this boy were curious enough to keep looking for organic connections to his condition and, lo and behold, their persistence lead to a diagnosis and solution for him. This diagnosis and treatment saved his life. Literally saved his life. Why doctors aren’t being sued left and right for failure to diagnose is a Kafkatrap because, to do so, the fear of revealing the identity of the doctor who actually diagnosed and treated the TBDs is enough to keep patients quiet…. fear of derailing the life and practice of the person who saved THEM who, among other things, might be the only treating Lyme dr for hundreds of miles. I hope I live to see the day when this is a non-issue.

  • Susan
    08/03/2018 (5:15 am)
    Reply

    I too was misdiagnosed at 17 with depression shortly after I had an EM rash. It is too easy for doctors to diagnose depression and prescribe tablets instead of looking further. The lazy attitude of doctors lead me to be misdiagnosed for another 30 years with depression even though I kept advising these professionals that I wasn’t depresssed but just unbareably and unbelievably tired. I can’t believe the difference treatment for lyme, bartonella,Rikketsia and babesia made to my life and you have no idea how annoyed I am that I was left to suffer for so long under the label of “depression”

  • David R Thomas
    05/24/2017 (11:44 pm)
    Reply

    If I had known about Lyme disease in the early 70’s. Which was unheard of then. I would not have chased Misdiagnosis after misdiagnosis for over 28 years. And I had a great diagnostician for a GP. this young man stands a chance I will not have. but sciences are changes and hopefully, there will be better recognition of those young people that fall through the cracks as we in the Lyme community fill those cracks.


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