Can Lyme Disease Cause Depression in Teenagers?
Depression may be part of neuropsychiatric Lyme disease
A teenager developed cognitive decline and mood symptoms
Treatment was followed by marked clinical improvement
One study found a high prevalence of depression in Lyme disease patients. Between January 2008 and December 2014, 1 in 5 patients treated at the Lyme Center Apeldoorn in the Netherlands was diagnosed with depression and Lyme disease.1
Meanwhile, Dr. Robert Bransfield, a psychiatrist specializing in the diagnosis and treatment of tick-borne illnesses, reports, “In my database, depression is the most common psychiatric syndrome associated with late-stage Lyme disease.”
“I estimate that there are at least 1,200 people per year who commit suicide as the result of Lyme disease,” Bransfield writes in his article “Suicide, Lyme and Associated Diseases.”2
Borrelia burgdorferi, the bacterium that causes Lyme disease, “may be diagnosed as a persistent infection with immune suppressant and evasive capabilities or there may be a postinfectious process,” Bransfield writes. “In either case, the psychiatric symptoms are associated with an immune-mediated process.”
Depression and Lyme disease
Depression can occur alongside a wide range of physical and cognitive symptoms associated with neuropsychiatric Lyme disease. Patients may experience mood changes, anxiety, irritability, sleep disturbances, memory problems, and difficulty concentrating.
Brian Fallon, MD, director of the Lyme and Tick-Borne Diseases Research Center at Columbia University, described the case of a 16-year-old adolescent who presented with long-standing depression that suddenly worsened.3
Teenager develops depression and cognitive decline
The teenager reported anger, frustration, insomnia, poor appetite, mild weight loss, and passive suicidal ideation. He would say, “I wish I could just die in my sleep.”
He also complained of brain fog and experienced a significant decline in cognitive function. His symptoms were initially presumed to be caused by “either laziness or mild depression.” He also suffered from ongoing knee pain and was forced to quit sports.
His grades dropped from A’s in seventh grade to nearly failing by tenth grade. He experienced fatigue and forgetfulness. “He appeared lazy because he found it hard to get out of bed in the morning,” Fallon wrote.
The teenager’s symptoms included:
- Severe headaches
- Facial fasciculations and myalgias
- Stiff neck
- Hyperacusis
- Episodic paresthesias of the face and hands
- Sudden sweating
- Painful joints
- Sore throats
- Palpitations
- Electric shock-like pains
- Word-finding difficulties
- Semantic paraphasias
- Short-term memory problems
- Testicular pain
Negative Lyme tests delayed recognition
Because the teenager reported embedded tick exposures in the past, Lyme disease was clinically suspected despite previous negative testing.
His Lyme ELISA results were negative twice during the prior three months. However, his IgG Western blot revealed four of the five CDC-specific bands required for surveillance reporting.
A brain SPECT scan demonstrated findings consistent with encephalitis, vasculitis, and Lyme disease.
This case highlights the challenges that can arise when laboratory findings do not fully align with the clinical presentation. It also reflects the broader challenges discussed in the limitations of Lyme disease testing.
Treatment improved depression and brain function
The teenager was diagnosed with probable Lyme encephalopathy, a manifestation of neurologic Lyme disease, and was treated with 12 weeks of intravenous ceftriaxone.
Following treatment, he experienced improvements in sleep, appetite, headaches, joint pain, numbness, distractibility, short-term memory, and emotional regulation.
His depression resolved without antidepressant medication. His IQ improved by 22 points, and his school performance improved substantially.
The case illustrates how symptoms attributed solely to depression may occasionally occur alongside other manifestations of Lyme disease, particularly in patients with complex neurologic and cognitive symptoms.
Frequently Asked Questions
Can Lyme disease cause depression?
Depression has been reported in some patients with Lyme disease, particularly those with neurologic or neuropsychiatric manifestations. The relationship is complex and may involve immune, inflammatory, and neurologic mechanisms.
Can Lyme disease be mistaken for depression?
Some patients with Lyme disease present with fatigue, cognitive difficulties, sleep disturbances, and mood changes that may initially resemble primary depression or other psychiatric conditions.
Can Lyme disease affect memory and concentration?
Yes. Patients may report memory difficulties, impaired concentration, slower processing speed, and brain fog, particularly in cases involving neurologic symptoms.
Can Lyme disease cause suicidal thoughts?
Suicidal thoughts have been reported in some patients with Lyme disease and associated neuropsychiatric symptoms. Any patient experiencing suicidal thoughts should seek immediate medical attention.
Can depression improve after Lyme disease treatment?
Some case reports describe improvement in depressive symptoms following treatment for Lyme disease, although outcomes vary among patients.
Clinical Takeaway
This case highlights the importance of considering Lyme disease in patients with depression accompanied by cognitive decline, neurologic symptoms, and a history of tick exposure. Neuropsychiatric symptoms may occasionally be part of a broader Lyme disease presentation.
Clinicians should consider Lyme disease in the differential diagnosis when depression occurs alongside brain fog, memory impairment, neurologic symptoms, and a compatible exposure history.
Related Articles
Don’t confuse somatic symptoms with depression in early Lyme disease
Chronic neurological Lyme disease or co-morbid conditions?
Oppositional behavior in children with Lyme disease
Can Lyme disease cause dementia?
References:
- Zomer TP, et al. Depressive Symptoms in Patients Referred to a Tertiary Lyme Center: High Prevalence in Those Without Evidence of Lyme Borreliosis. Clin Infect Dis. 2017;65(10):1689-1694.
- Bransfield RC. Suicide and Lyme and Associated Diseases. Neuropsychiatr Dis Treat. 2017;13:1575-1587.
- Fallon BA, Kochevar JM, Gaito A, Nields JA. The underdiagnosis of neuropsychiatric Lyme disease in children and adults. Psychiatr Clin North Am. 1998;21(3):693-703.
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
If I had known about Lyme disease in the early 70’s. Which was unheard of then. I would not have chased Misdiagnosis after misdiagnosis for over 28 years. And I had a great diagnostician for a GP. this young man stands a chance I will not have. but sciences are changes and hopefully, there will be better recognition of those young people that fall through the cracks as we in the Lyme community fill those cracks.
I too was misdiagnosed at 17 with depression shortly after I had an EM rash. It is too easy for doctors to diagnose depression and prescribe tablets instead of looking further. The lazy attitude of doctors lead me to be misdiagnosed for another 30 years with depression even though I kept advising these professionals that I wasn’t depresssed but just unbareably and unbelievably tired. I can’t believe the difference treatment for lyme, bartonella,Rikketsia and babesia made to my life and you have no idea how annoyed I am that I was left to suffer for so long under the label of “depression”
“His Lyme ELISA results were negative twice in the prior 3 months, but his IgG Western blot revealed 4 of the 5 requisite CDC specific bands. A brain SPECT revealed findings consistent with encephalitis, vasculitis,
and Lyme disease.
Treatment response
The boy was diagnosed with probable Lyme encephalopathy and treated with 12 weeks of intravenous ceftriaxone.
He improved on sleep, appetite, headaches, joint pains, numbness, distractibility, short-term memory, and emotional behavior. His depression cleared without the need for antidepressant medications. His IQ improved by 22 points, and his school performance markedly improved.”
This is the most stunning piece of the whole story to me…. that any medical practitioner can deny the havoc Lyme can deliver to a young person’s (any person’s) life is inexcusable in the light of the actual RESULTS of persistent curiosity in light of THREE negative ELISA tests (most regular doctors stop at one, hand the patient an Rx for Xanax and send them home). The doctors working with this boy were curious enough to keep looking for organic connections to his condition and, lo and behold, their persistence lead to a diagnosis and solution for him. This diagnosis and treatment saved his life. Literally saved his life. Why doctors aren’t being sued left and right for failure to diagnose is a Kafkatrap because, to do so, the fear of revealing the identity of the doctor who actually diagnosed and treated the TBDs is enough to keep patients quiet…. fear of derailing the life and practice of the person who saved THEM who, among other things, might be the only treating Lyme dr for hundreds of miles. I hope I live to see the day when this is a non-issue.
My friend and his parents allowed him to just END his life because doctors here in
Canada are so dumb!!!!