Bartonella psychiatric symptoms can include agitation, panic disorder, and treatment-resistant depression. In their 2007 article, “Do Bartonella Infections Cause Agitation, Panic Disorder, and Treatment-Resistant Depression?” Schaller and colleagues describe three patients with acute psychiatric symptoms associated with Bartonella-like signs and symptoms.
Each patient was exposed to ticks or fleas and manifested symptoms consistent with Bartonella — including an enlarged lymph node near an Ixodes tick bite and bacillary angiomatosis found only in Bartonella infections.
The authors conclude: “We have presented case studies of patients with new clear psychiatric morbidity, sudden agitation, panic attacks, and treatment-resistant depression, all possibly attributed to Bartonella.”
The patients were treated at an outpatient clinic for acute-onset personality changes including agitation, depression, and panic attacks. Treatment with psychotropics alone was not effective in relieving their Bartonella psychiatric symptoms. However, after receiving antibiotic treatment for presumed Bartonella, psychotropic doses were reduced and all patients improved significantly, returning to their baseline mental health status.
Case 1: Rage and Agitation After Tick Bites
A 41-year-old man had a complete personality change, according to his family, following a camping trip in North Carolina. He developed a small, aching right-sided axillary lymph node and fever after the trip. He had removed three deer ticks from his leg and shoulder.
Five weeks later, he exhibited irritability, severe insomnia, rage, and sensitivity to smells and sounds. He also reported an enlarged and persistent right-sided axillary lymph node.
Lyme disease testing was negative. However, clinicians suspected Bartonella given his unilateral lymph node symptom and tick bite. A PCR test for two Bartonella species was initially negative but positive for B. henselae when repeated.
During the next two weeks, the patient developed serious agitation, panic attacks, and major depression. He was so agitated that during arguments with his spouse, he threw objects into the walls of his home. He was diagnosed with bipolar disorder despite no previous history of depression or mania. Psychotropic medications did not relieve his symptoms.
An infectious disease clinician prescribed azithromycin and rifampin for suspected Bartonella infection. After eight weeks of treatment, the patient’s lymph node complaints resolved and his psychiatric symptoms were reduced substantially. His personality returned to approximately 90% of baseline, according to his spouse and closest friend.
Case 2: Panic Attacks After Cat Exposure
A medical student reported a rash on her thighs consisting of four linear lines after adopting two young cats from a shelter. She also reported several flea bites.
The patient complained of new panic attacks, profound restlessness, and depression that began around the time of her new rashes. Treatment with psychotropic medications was not effective.
Her nurse practitioner suspected Bartonella and prescribed cefuroxime and azithromycin. During the first week of treatment, the woman became increasingly sad, irritable, and hopeless with increased panic attacks. By week two, symptoms had subsided slightly. By week three, the rash had disappeared. By week eight, her depression and anxiety had improved substantially.
Six months later, some symptoms reappeared — moderate inappropriate anger, excess interpersonal sensitivity, severe premenstrual dysphoric disorder, irritability, and sadness. She was retreated with rifampicin and cefdinir and improved.
Antibiotics Reduced the Need for Psychotropics
All patients initially required higher doses of psychotropic medications to function normally. Following antibiotic treatment, doses were reduced or stopped entirely as Bartonella psychiatric symptoms appeared to remit. This pattern suggests that Bartonella psychiatric symptoms may respond better to antibiotics targeting the underlying infection rather than psychiatric medications alone.
Clinical Perspective
These cases illustrate a pattern that clinicians evaluating psychiatric symptoms in tick-exposed patients should recognize: sudden personality changes, rage, panic, and treatment-resistant depression that appear after tick or flea exposure may signal Bartonella infection rather than primary mental illness.
When psychotropic medications fail and symptoms correlate with physical findings such as lymphadenopathy, rashes, or fatigue, the possibility of Bartonella deserves evaluation — even when initial testing is negative, as this study demonstrates with an initially negative PCR that was positive on repeat.
Frequently Asked Questions
Can Bartonella cause psychiatric symptoms?
Yes. Bartonella psychiatric symptoms can include agitation, panic attacks, rage, treatment-resistant depression, and sudden personality changes.
How is Bartonella transmitted?
Bartonella can be transmitted through tick bites, flea bites, cat scratches, and other animal exposures.
Do psychiatric medications help Bartonella symptoms?
In these cases, psychotropic medications alone were not effective. Patients improved after receiving antibiotic treatment targeting Bartonella.
What antibiotics are used for Bartonella?
Treatment combinations included azithromycin with rifampin and cefuroxime with azithromycin. Treatment duration was typically eight weeks or longer.
Can Bartonella testing be negative even when infection is present?
Yes. In one case, PCR testing was initially negative for Bartonella but positive on repeat. A single negative test does not rule out infection.
References
- Schaller JL, Burkland GA, Langhoff PJ. Do Bartonella infections cause agitation, panic disorder, and treatment-resistant depression? MedGenMed. 2007;9(3):54.
Dr Cameron, I’m under the care of an LLMD in my area (Central New Jersey) for Lyme and Bartonella. I was on doxy and Clarithromycin for 4 1/2 months after catching the symptoms early (I’ve had Lyme several times before). I stopped taking the antibiotics after I got a terrible intestinal Candida infection that I couldn’t get rid of while on the antibiotics. After almost three weeks on Diflucan, I feel better. Is 4 1/2 months of antibiotics generally long enough to treat Bartonella? I’m reading between 4 and 6 months and I’m in that range. I ask because my LLMD – there aren’t a lot available in my area – feels that I should keep taking the antibiotics but the problems the problems they’re now causing are just as bad as the original infection.
I have had patients who have benefited from treatment for other tick borne infections ie Lyme with Ceftin or Babesia with Malarone, I sometimes have used lower doses or single therapy. Finally, I have had to refer to rule out other issues.
Hi Dr. Cameron! I just wanted to ask a question If that’s OK. My teenage daughter was diagnosed with Bartonella. She has always had some level of psychiatric issues, including OCD, and then after the tick bite things got so much worse for her mental health. She’s been on antibiotics for three months and the lines on the back of her knees have lightened up dramatically, with only just a little bit of red at the top of one of the stria. Her Mental health actually seems to be getting much worse as treatment goes on. I don’t think this is normal and I was wondering if there were any other cases like this that you have seen. Thank you!
I have other cases. In some cases, they have another co-infection like Babesia that is leading to the psychiatric problems.
We need help! My daughter has had Lyme disease and two of its co-infections since she was 13, 1994! When I took her in to the doctor, I said, “I think she has a tick related illness”. She had swelling around her eyes! 6 years later she was diagnosed! She has been treated periodically since that time! She was going along the last few years, okay. A little more energy, and actually enjoying life a bit! Then wham! Horrible anxiety, panic attacks, depression, anxiety! She’s been in two rehab facilities, with suicidal ideation! It has been a nightmare! Her Lyme doc immediately said her Bart was acting up! He started her on way too heavy of a protocol, and that was worse. Herring, and mental problems! Do you have any ideas? We are at the end of our rope, and don’t want to lose our daughter!
I face the same challenges. I have found lower doses helpful including a pediatric dose treatment for Babesia. I have also found it helpful to include some counseling during my visits. All the best on your journey.
Are there any hospital or care centers that treat Bartonella and mental illness at the same time.
I am not aware of a hospital. There are doctor who are experienced in evaluating for a tick borne infection