After 37 years treating Lyme disease, I’ve seen brain fog and anxiety misdiagnosed as purely psychiatric disorders.
She came to me after eight months of worsening psychiatric symptoms, including severe anxiety, episodes of rage, obsessive-compulsive behaviors, and deepening depression.
She had been diagnosed with a primary psychiatric disorder and spent months cycling through counseling and multiple medication trials. Despite doing everything she was told, nothing helped.
By the time I met her, she was exhausted, discouraged, and beginning to lose hope—yet her symptoms pointed to Lyme disease symptoms, not mental illness.
When Psychiatric Symptoms Overlap With Physical Illness
What caught my attention was not only the severity of her psychiatric symptoms, but what accompanied them.
She also described persistent brain fog, profound fatigue, and dizziness when standing—features suggestive of autonomic dysfunction, including symptoms consistent with postural orthostatic tachycardia syndrome (POTS).
These physical symptoms are often overlooked in psychiatric evaluations, yet they are commonly seen in patients with post-treatment Lyme disease syndrome (PTLDS) and neurologic Lyme disease.
When I asked about possible tick exposure, she hesitated. She had never noticed a tick bite or a rash. But Lyme disease does not always present with a visible bite or the classic erythema migrans rash.
Relying on those signs alone can lead to missed diagnoses.
Taken together, her symptoms—psychiatric distress, cognitive dysfunction, and orthostatic intolerance—matched patterns I have seen repeatedly in patients whose brain fog and anxiety reflect a systemic illness rather than a primary psychiatric condition.
A Turning Point When the Diagnosis Changed
The disconnect between her psychiatric diagnosis and accompanying physical symptoms prompted a broader evaluation.
We tested for Lyme disease and common co-infections. Her results were consistent with a past Lyme infection. Based on her clinical history and presentation, we initiated treatment.
Over the following weeks, the change was striking.
Her anxiety began to ease. Episodes of rage diminished. Obsessive-compulsive behaviors softened. The depression that had kept her barely functioning started to lift.
Her energy improved, and the brain fog that had made even simple tasks feel overwhelming began to clear.
She later described the experience as “waking up” from something she had not even realized had taken hold of her mind.
Why These Symptoms Are Often Misdiagnosed
When psychiatric treatments fail to bring relief, clinicians should consider whether an underlying medical condition may be contributing. In many cases, Lyme disease neuroinflammation plays a central role.
Immune activation within the brain can disrupt autonomic regulation, alter neurotransmitter signaling, and impair communication between brain regions—producing symptoms that closely resemble anxiety disorders, OCD, bipolar disorder, or major depression.
Patients whose cognitive and mood symptoms are driven by neuroinflammation are frequently diagnosed with primary psychiatric conditions and treated exclusively with psychiatric medications.
When the underlying biologic process remains unrecognized, these treatments may offer limited benefit.
Lyme Disease and the Autonomic Nervous System
Lyme disease neuroinflammation often overlaps with dysfunction of the autonomic nervous system.
Inflammatory signaling can disrupt communication between the brain and body, contributing to palpitations, dizziness, shortness of breath, nausea, temperature instability, and internal tremulousness.
When autonomic symptoms combine with limbic system activation, anxiety and panic can feel abrupt and physical.
Clinical Takeaway
After 37 years treating Lyme disease, when brain fog and anxiety occur together—especially after infection—neuroinflammation should be considered a physiologic contributor rather than dismissed as purely psychological. Immune activation within the brain disrupts autonomic regulation, alters neurotransmitter signaling, and produces symptoms resembling anxiety disorders, OCD, or depression. If anxiety feels unfamiliar and accompanies cognitive or neurologic symptoms, it deserves evaluation beyond a standard psychiatric workup.
Frequently Asked Questions
Can Lyme disease cause anxiety and panic attacks?
Yes. Immune activation and neuroinflammation sensitize brain circuits involved in threat detection and autonomic regulation, producing anxiety and panic that feel abrupt and physical.
Why does Lyme-related anxiety feel different?
Lyme anxiety is often driven by immune–nervous system signaling rather than thought patterns alone, which is why it feels more physical and unpredictable.
Can Lyme disease cause brain fog and anxiety at the same time?
Yes. These symptoms frequently appear together and may reflect neuroinflammation affecting both cognitive and emotional processing simultaneously.
Do psychiatric medications treat Lyme disease neuroinflammation?
Psychiatric medications may reduce symptoms for some patients but do not address the underlying inflammatory process driving the symptoms.
When should Lyme disease be considered in psychiatric patients?
When psychiatric symptoms appear alongside brain fog, autonomic dysfunction, fatigue, or joint pain—and when standard psychiatric treatments fail to bring expected improvement.
Related Reading
Lyme Disease Symptoms: What Patients Need to Know
Neuropsychiatric Lyme: Infection, Not Mental Illness
Lyme Disease Depression: When Infection Looks Like Mental Illness
Brain Fog and Lyme Disease: The Overlooked Symptom
Dysautonomia in Lyme Disease
Lyme Disease Was Misdiagnosed as OCD
References
- Fallon BA, Nields JA. Lyme disease: a neuropsychiatric illness. Am J Psychiatry. 1994;151(11):1571–1583.
- Dantzer R, et al. From inflammation to sickness and depression. Nat Rev Neurosci. 2008;9(1):46–56.
- Miller AH, Raison CL. The role of inflammation in depression: from evolutionary imperative to modern treatment target. Nat Rev Immunol. 2016;16(1):22–34.
