Don’ t confuse somatic symptoms with depression in early Lyme disease
Patients with early Lyme disease appeared to be depressed when evaluated with the Beck Depression Inventory (BDI-II) tool, according to a study by Wormser and colleagues, published in the American Journal of Medicine.  But after antibiotic treatment, the patients’ BDI-II scores returned to normal, leading the authors to conclude that these patients, in fact, did not suffer from depression.
The 1-year prospective study included 52 adult Lyme disease patients with erythema migrans (EM) rashes. Their somatic symptoms included fatigue, headache, joint pain, muscle pain, and cognitive complaints.
Individuals with the worst symptoms had the worst BDI-II scores. The BDI-II scale has been used as a screening tool for patients who might benefit from further psychological evaluation for diagnosing depression.
“There was a good to excellent direct correlation between the BDI-II score and the total number of symptoms,” writes Wormser, “suggesting that the BDI-II scores were reflecting somatic rather than affective depressive symptoms.”
When using the BDI-II assessment tool for patients with Lyme disease, “infection-related somatic symptoms per se need to be considered in the interpretation of results,” the authors conclude.
If depression is suspected, the authors recommend a psychological referral. In fact, at the 6 month visit, one patient in their study was referred for a depression evaluation based on the Beck Depression Inventory.
“The single Lyme disease patient with a score regarded as severe, which was found only at the 6 month visit, was treated by a mental health professional between the 6 and 12 months visits, and improved by the 12 month visit. This patient had a prior history of depression when she was pregnant.”
- Wormser GP, Park K, Madison C, et al. Evaluation of Prospectively Followed Adult Patients with Erythema Migrans Using the Beck Depression Inventory Second Edition. Am J Med. 2018.