She came to my office after seeing three different doctors. Each time, she heard the same thing: “You’re probably just depressed.”

But something didn’t sit right with her — and it didn’t sit right with me either.

When the Diagnosis Doesn’t Tell the Whole Story

Depression is serious. But it’s not the explanation for every symptom a patient experiences.

By the time this patient found me, her fatigue was overwhelming. Her joints ached unpredictably. Her thoughts were cloudy, her memory slipping in ways that felt frightening. She wasn’t just sad or withdrawn — she was physically sick, and she knew it. Still, because she had a history of depression, her new symptoms were brushed aside.

Nobody asked about the pattern of her pain. Nobody noticed how it migrated from joint to joint. Nobody questioned why sleep didn’t restore her energy. Nobody considered that this could be something more.

What Happens When We Stop Asking Questions

I see this happen more often than I’d like to admit. Once a label like “depression” — or any mental health diagnosis — is placed on a patient’s chart, everything that follows gets filtered through that lens. Headaches become stress. Fatigue becomes depression. Brain fog becomes anxiety.

But medicine — and healing — require curiosity. They require us to ask: “What else could be going on?”

When I sat down and listened to her full story, it was clear her symptoms didn’t fit neatly into a mental health box. They fluctuated, migrated, and worsened unpredictably — patterns we often see with infection and inflammation, not simply mood disorders.

So we dug deeper. I ordered testing for Lyme disease. And we found it.

Lyme Disease Doesn’t Always Look the Way We Expect

One of the reasons Lyme disease depression is so often missed is because it doesn’t always look the way doctors are trained to recognize it. No obvious tick bite. No bull’s-eye rash. No early flu-like illness.

Instead, it can look like depression, anxiety, chronic fatigue, cognitive decline, mood swings, or brain fog. Because Lyme can affect the immune system, nervous system, joints, and brain, it creates a complicated picture that’s easy to misread — especially when doctors stop asking questions.

Other Mental Health Diagnoses That Can Mask Lyme Disease

Depression isn’t the only diagnosis that can mask an underlying Lyme infection. I’ve seen patients misdiagnosed with anxiety disorders, panic attacks, bipolar disorder, obsessive-compulsive disorder, somatic symptom disorder, and post-traumatic stress disorder.

These are legitimate conditions that deserve appropriate attention. But Lyme disease can mimic many of their symptoms — emotional instability, irritability, panic episodes, severe fatigue, and cognitive slowing. When we anchor too quickly to a psychiatric explanation, we can miss a medical illness that is still active and still treatable.

Bartonella, a common co-infection, can produce sudden rage, agitation, and treatment-resistant depression that further complicates the picture.

Treatment Changed Everything

When we treated her Lyme disease, her health started to return. Her energy came back. Her brain fog lifted. Her joint pain improved. Her mood stabilized — not because she changed medications, but because her infection was finally being treated.

She began feeling like herself again — regaining not just her physical strength, but her mental clarity and emotional resilience too.

It confirmed what she had known deep down all along: this wasn’t just depression. This was Lyme disease.

Clinical Perspective

Lyme disease depression can look identical to primary depression — until you notice the pattern. Migratory pain, fatigue that doesn’t respond to rest, cognitive difficulty that worsens unpredictably, and symptoms that resist standard antidepressants are all clues that something beyond mood is involved.

If you’re struggling with symptoms that don’t feel fully explained — fatigue, brain fog, pain, mood changes — and you’ve been told it’s “just depression,” trust yourself. Keep asking questions. Find someone willing to look deeper. Because sometimes, the correct diagnosis is still waiting to be found.

Frequently Asked Questions

Can Lyme disease cause depression?
Yes. Lyme disease can directly affect the central nervous system, producing depression through neuroinflammation rather than a primary mood disorder.

How is Lyme disease depression different from regular depression?
Lyme disease depression often appears suddenly, resists standard antidepressant treatment, and occurs alongside physical symptoms like fatigue, joint pain, brain fog, and sleep disruption.

Why do doctors miss Lyme disease in depressed patients?
Once a psychiatric diagnosis is on the chart, new symptoms tend to be filtered through that lens. Doctors evaluating depression rarely test for tick-borne infections, even in endemic areas.

Can Lyme disease depression improve with antibiotics?
Yes. Many patients experience significant improvement in mood, energy, and cognition when the underlying Lyme infection is treated — sometimes without any changes to psychiatric medication.

Should depressed patients be tested for Lyme disease?
When depression appears suddenly, resists treatment, or occurs alongside systemic symptoms like migratory pain, fatigue, or cognitive difficulty — particularly in patients with tick exposure — Lyme disease testing is warranted.

References

1. Fallon BA, Nields JA. Lyme disease: a neuropsychiatric illness. Am J Psychiatry. 1994;151(11):1571–1583.
2. Bransfield RC. Neuropsychiatric Lyme borreliosis: an overview with a focus on a specialty psychiatrist’s clinical practice. Healthcare. 2018;6(3):104.
3. Batheja S, et al. Post-treatment Lyme syndrome and central sensitization. J Neuropsychiatry Clin Neurosci. 2013;25(3):176–186.

Related Reading

• Psychiatric Lyme Disease: Misdiagnosed as Mental Illness
• Bartonella Psychiatric Symptoms: When Antibiotics Work Better
• Lyme Disease: “You Need to See a Psychiatrist”
• Don’t Confuse Somatic Symptoms with Depression in Early Lyme Disease
• 16-Year-Old Boy with Lyme Disease Presenting as Depression
• Medical Dismissal and Lyme Disease
• Brain Fog and Lyme Disease