Lyme Disease Suicide Risk and Psychiatric Symptoms

Psychiatric symptoms have been reported in Lyme disease
Suicidal or violent thoughts require urgent evaluation
Medical and psychiatric causes should be considered

This podcast discusses Lyme disease suicide risk, psychiatric symptoms, and why urgent support is important when severe emotional or behavioral symptoms occur.

If You Are in Crisis Now

If you are thinking about suicide, harming yourself, or harming someone else, call or text 988 in the United States now. The 988 Suicide & Crisis Lifeline provides free, confidential support 24 hours a day.[6]

If there is immediate danger, call 911 or go to the nearest emergency department.

You can also visit 988lifeline.org.

Welcome to another selection from my book An Expert’s Guide on Navigating Lyme Disease. The book highlights findings from my first 600 Lyme disease science blogs. In this episode, I discuss suicide risk and severe psychiatric symptoms reported in some patients with Lyme disease and associated tick-borne illnesses.

Psychiatric symptoms associated with Lyme disease may include depression, anxiety, irritability, panic, intrusive thoughts, cognitive difficulties, emotional dysregulation, sleep disturbances, and, more rarely, suicidal thinking or aggression.

These presentations appear uncommon, but severe psychiatric deterioration, suicidal thoughts, violent intrusive thoughts, or homicidal thinking should always be treated as urgent.

This article is not intended to suggest that Lyme disease explains every psychiatric symptom. Instead, severe psychiatric symptoms deserve careful medical, neurologic, and psychiatric evaluation along with appropriate safety planning.

Psychiatric Symptoms Reported in Lyme Disease

Published reports and clinical observations have described a broad range of psychiatric symptoms associated with Lyme disease and associated tick-borne illnesses.[1-5]

• Depression
• Anxiety and panic symptoms
• Intrusive thoughts
• Irritability and mood instability
• Aggression or explosive anger
• Cognitive dysfunction and brain fog
• Sleep disturbances
• Suicidal thoughts

Many of these symptoms overlap with findings discussed in neuropsychiatric Lyme disease, brain fog and anxiety in Lyme disease, and neurologic Lyme disease.

Lyme Disease Suicide Risk and Aggression

Dr. Robert Bransfield has described suicidal and homicidal concerns in patients with Lyme disease and associated illnesses seen in clinical practice.[1,4]

In a clinical sample of 253 patients described by Bransfield, suicidal symptoms occurred in some patients alongside depression, explosive anger, aggression, or other severe psychiatric symptoms.[1] Because this was a selected clinical population rather than a population-based study, the findings cannot establish how frequently these symptoms occur among all patients with Lyme disease.

Dr. Bransfield reported that some patients experienced suicidal symptoms alone, while others had combinations of depression, explosive anger, aggression, or intrusive thoughts.[1]

In my practice, I have seen patients report suicidal thoughts without a specific plan or intent. I have also seen patients describe distressing thoughts of violence without an intention or plan to harm another person. These experiences should still be taken seriously and evaluated promptly, because symptoms and safety risks can change.

These observations do not mean Lyme disease explains every psychiatric illness, but they suggest clinicians should carefully evaluate psychiatric symptoms in the setting of complex medical presentations.

Population-Level Evidence

Population-level evidence also supports an association. In a nationwide Danish cohort study, Fallon and colleagues found that individuals diagnosed with Lyme borreliosis in a hospital setting had higher risks of mental disorders, affective disorders, suicide attempts, and death by suicide compared with individuals without the diagnosis.[7]

The study demonstrated an association but did not establish that Lyme disease directly caused an individual psychiatric presentation.

Published Reports of Severe Psychiatric Symptoms

Several published case reports have described severe neuropsychiatric presentations associated with Lyme disease.

Munir and colleagues described suicidal and homicidal tendencies in a patient without a prior psychiatric history who later received a diagnosis of Borrelia infection.[2]

Banerjee and colleagues reported improvement in psychiatric symptoms and suicidal ideation following treatment in a published case report.[3] A case report cannot establish that the same response will occur in other patients.

Additional discussions regarding severe neuropsychiatric presentations are available in Lyme disease and depression.

Why Psychiatric Symptoms May Be Missed

Psychiatric symptoms may be fragmented across multiple specialties and overlap with fatigue, pain, sleep disorders, autonomic dysfunction, cognitive impairment, medication effects, or other medical illnesses.

These overlapping presentations are discussed further in autonomic dysfunction in Lyme disease.

Careful evaluation helps avoid both under-recognition and over-attribution.

Frequently Asked Questions

Can Lyme disease be associated with suicidal thoughts?

Some published reports, clinical observations, and population-level research have found an association between Lyme disease and suicidal behavior. Any suicidal thought requires urgent evaluation regardless of its suspected cause.

Can Lyme disease cause psychiatric symptoms?

Psychiatric symptoms have been reported in some patients with Lyme disease, including depression, anxiety, sleep problems, cognitive symptoms, mood changes, and emotional dysregulation. These symptoms can have many possible causes and require careful evaluation.

Can aggression occur in Lyme disease?

Published reports describe aggression, explosive anger, and intrusive violent thoughts in some patients. These appear to be uncommon presentations and should not automatically be attributed to Lyme disease.

Should psychiatric symptoms automatically be blamed on Lyme disease?

No. Psychiatric symptoms may have psychiatric, neurologic, infectious, medication-related, or other medical causes.

When should someone seek emergency help?

Anyone experiencing suicidal thoughts, homicidal thoughts, or immediate safety concerns should seek urgent help immediately. In the United States, call or text 988. Call 911 or go to the nearest emergency department if there is immediate danger.

Clinical Takeaway

Severe psychiatric symptoms reported in patients with Lyme disease deserve careful attention without assuming that infection is the only possible explanation. Medical, neurologic, psychiatric, medication-related, and other potential causes should be considered.

Suicidal or homicidal thoughts should always be treated as urgent regardless of their suspected cause.

Related Articles

Lyme disease symptoms guide
Lyme disease test accuracy
Persistent Lyme disease overview
Recovery from Lyme disease

References

1. Bransfield RC. Suicide and Lyme and associated diseases. Neuropsychiatr Dis Treat. 2017;13:1575-1587.
2. Munir A, Aadil M, Khan AR. Suicidal and homicidal tendencies after Lyme disease: an ignored problem. Neuropsychiatr Dis Treat. 2017;13:2069-2071.
3. Banerjee R, Liu JJ, Minhas HM. Lyme neuroborreliosis presenting with alexithymia and suicide attempts. J Clin Psychiatry. 2013;74(10):981.
4. Bransfield RC. Aggressiveness, violence, homicidality, homicide, and Lyme disease. Neuropsychiatr Dis Treat. 2018;14:693-713.
5. Bransfield RC, Embers ME, Dwork AJ. Late-stage borreliosis and substance abuse. Heliyon. 2024;10(10):e31159.
6. 988 Suicide & Crisis Lifeline. Get help now.
7. Fallon BA, Madsen T, Erlangsen A, et al. Lyme borreliosis and associations with mental disorders and suicidal behavior: a nationwide Danish cohort study. Am J Psychiatry. 2021;178(10):921-931.

---

Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention