Perspective: Lyme disease patients’ mental and physical health in a COVID-19 pandemic
People from around the world are gripped with worry about the COVID-19 pandemic as an increasing number of studies report long-lasting illnesses and mental health problems among some patients. Lyme disease patients can identify, as many express apprehension over their own mental health during the pandemic.
A broad range of factors associated with mental health problems in COVID-19 were identified in an epidemiologic review. “Age, gender, marital status, education, occupation, income, place of living, close contact with people with COVID-19, comorbid physical and mental health problems, exposure to COVID-19 related news and social media, coping styles, stigma, psychosocial support, health communication, confidence in health services, personal protective measures, risk of contracting COVID-19, and perceived likelihood of survival,” writes Hossain and colleagues. 
Lyme disease mental health
A broad range of mental health issues has been described in Lyme disease. In a 1990 report, Logigian and colleagues from Tufts University School of Medicine, in Boston, describe rage in patients with chronic neurologic Lyme disease. “Eight patients had excessive daytime sleepiness, and seven had extreme irritability. They became angry over circumstances that previously caused only minor annoyance.” 
Dr. Fallon and colleagues from the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, in New York, have described a wide range of neuropsychiatric complications associated with Lyme disease. The authors described Lyme disease patients exhibiting “paranoia, dementia, schizophrenia, bipolar disorder, panic attacks, major depression, anorexia nervosa, and obsessive-compulsive disorder.” 
Dr. Bransfield from Rutgers-Robert Woods Johnson Medical School, Department of Psychiatry, also shared his understanding of the role in which Lyme disease may cause mental health symptoms. “LB [Lyme borreliosis] causes immune and metabolic effects that result in a gradually developing spectrum of neuropsychiatric symptoms, usually presenting with significant comorbidity which may include developmental disorders, autism spectrum disorders, schizoaffective disorders, bipolar disorder, depression, anxiety disorders (panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, intrusive symptoms), eating disorders, decreased libido, sleep disorders, addiction, opioid addiction, cognitive impairments, dementia, seizure disorders, suicide, violence, anhedonia, depersonalization, dissociative episodes, derealization, and other impairments,” writes Bransfield. 
Lyme disease physical health
The list of physical health conditions associated with Lyme disease continues to grow. The list now includes:
- Lyme encephalopathy [2.5]
- Lyme neuropathy 
- Lyme carditis 
- Autonomic dysfunction – Positional Orthostatic Tachycardic Syndrome (POTS) 
- Post-treatment Lyme fatigue – Post-Lyme disease 
- Neuropathic pain 
- Persistent symptoms after Lyme disease 
- Lyme disease with co-infection (e.g., Babesia) 
The mental and physical health of Lyme disease patients described by these authors is not fully understood. Nevertheless, we need to address these concerns, as Lyme disease patients are genuinely concerned about the COVID-19 pandemic. Clinicians should be aware that Lyme disease patients frequently exhibit mental health symptoms similar to those present with COVID-19. And should therefore not immediately dismiss Lyme disease for COVID-19.
- Hossain MM, Tasnim S, Sultana A, et al. Epidemiology of mental health problems in COVID-19: a review. F1000Res. 2020;9:636.
- Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med. 1990;323(21):1438-1444.
- Fallon BA, Nields JA. Lyme disease: a neuropsychiatric illness. Am J Psychiatry. 1994;151(11):1571-1583.
- Bransfield RC. Neuropsychiatric Lyme Borreliosis: An Overview with a Focus on a Specialty Psychiatrist’s Clinical Practice. Healthcare (Basel). 2018;6(3).
- Fallon BA, Keilp JG, Corbera KM, et al. A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy. Neurology. 2008;70(13):992-1003.
- Halperin JJ, Little BW, Coyle PK, Dattwyler RJ. Lyme disease: cause of a treatable peripheral neuropathy. Neurology. 1987;37(11):1700-1706.
- Muehlenbachs A, Bollweg BC, Schulz TJ, et al. Cardiac Tropism of Borrelia burgdorferi: An Autopsy Study of Sudden Cardiac Death Associated with Lyme Carditis. Am J Pathol. 2016;186(5):1195-1205.
- Kanjwal K, Karabin B, Kanjwal Y, Grubb BP. Postural orthostatic tachycardia syndrome following Lyme disease. Cardiol J. 2011;18(1):63-66.
- Krupp LB, Hyman LG, Grimson R, et al. Study and treatment of post Lyme disease (STOP-LD): a randomized double masked clinical trial. Neurology. 2003;60(12):1923-1930.
- Simons LE. Fear of pain in children and adolescents with neuropathic pain and complex regional pain syndrome. Pain. 2016;157 Suppl 1:S90-97.
- Klempner MS, Hu LT, Evans J, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med. 2001;345(2):85-92.
- Krause PJ, Telford SR, 3rd, Spielman A, et al. Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness. JAMA. 1996;275(21):1657-1660.
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