Somatic Symptoms vs Depression in Lyme Disease
Depression scores in Lyme disease patients may reflect physical symptoms rather than a primary mood disorder.
A one-year prospective study followed 52 adult Lyme disease patients presenting with erythema migrans (EM). Participants reported symptoms including fatigue, headaches, joint pain, muscle pain, and cognitive complaints.
Patients with more severe physical symptoms had higher scores on the Beck Depression Inventory–II (BDI-II), a screening tool commonly used to assess depression.
BDI-II Scores Reflect Somatic Burden
“There was a good to excellent direct correlation between the BDI-II score and the total number of symptoms,” writes Wormser, suggesting that scores reflected somatic symptoms rather than affective depression.
Fatigue, brain fog, sleep disruption, and pain can elevate depression scores without indicating a primary psychiatric condition.
When Is a Mental Health Referral Appropriate?
If depression is suspected after clinical evaluation, referral for psychological assessment may be appropriate.
In the study, one patient with a prior history of depression improved after receiving mental health care between follow-up visits.
Clinical Perspective
Elevated depression screening scores in Lyme disease may reflect the burden of physical illness rather than a primary mood disorder.
Clinicians who refer patients to psychiatry based solely on screening scores risk mislabeling infection-related symptoms as psychiatric illness.
This does not mean depression should be ignored—but it must be interpreted in clinical context.
For more, see psychiatric Lyme disease.
Clinical Takeaway
Depression scores in Lyme disease often reflect somatic symptoms. Interpret screening tools with caution.
References
- Wormser GP, Park K, Madison C, et al. Evaluation of Lyme disease patients using BDI-II. Am J Med. 2019.
Related Reading
- Psychiatric Lyme Disease
- Lyme Disease Depression
- Lyme presenting as depression
- “You Need to See a Psychiatrist”
- Brain Fog in Lyme Disease
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
this seems a little confusing. The depression is real but not caused by the infection/co-infection. It is caused by overthinking the future of one’s life and the quality one will have with no absolute answers.
The depressive symptoms appeared related to the illness rather than a clinical diagnosis of depression. The Beck Depression Inventory cannot tell the difference between clinical depression and somatic issues related to the illness.
Dr Cameron,
A loved one has in the last 7 mos experienced leg cramps, progressing into fasiculations, numbness/tingling, burning, and leg weakness. Depression also. Will see a neurologist soon. Not sure if it is CIPD, MS, or much worse. Read your website and Dr Tedone’s (winningthefight.org) where he strongly feels it contributes/causes ALS and many neurodegenerative diseases? Therefore want to get the test for Borrelia infection. You are the expert. Please advise where to go for the most accurate test for Lyme Disease? Is it at iGenex? If it is negative should testing be repeated again? If it’s positive, what are the proper antibiotics and for how long? Have you seen these antibiotics work on neurological symptoms? Please help us with your expertise. Most neurologists we’ve briefly talked to don’t believe there is a link! Lastly, if we would like a phone consultation with you, how do we get in touch with you? Thanks, Joe at he****@*****lo.edu
It can be so frustrating too see your loved one ill for 7 months. The list of possible diagnoses can be overwhelming at the beginning. The laboratory testing can be frustrating at the start. Even specialty labs are not as reliable as we would like. I see patients with similar presentations. Call my office at 914 666 4665 with questions.