Lyme Disease Patients’ Mental and Physical Health During COVID-19

Lyme disease patients’ mental and physical health during the COVID-19 pandemic has become an important concern. Many of the factors associated with mental health problems during COVID-19 have also been observed in individuals with Lyme disease.

In an epidemiologic review of COVID-19 mental health research, Hossain and colleagues identified a wide range of contributing factors including age, gender, marital status, education, occupation, income, place of living, close contact with individuals infected 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 behaviors, perceived risk of contracting COVID-19, and perceived likelihood of survival. [1]

Lyme disease mental health

A broad range of mental health issues has long been described in patients with Lyme disease. In a 1990 report, Logigian and colleagues from Tufts University School of Medicine described emotional and behavioral changes 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.” [2]

Dr. Brian Fallon and colleagues from the Department of Psychiatry at Columbia University have also described a wide range of neuropsychiatric complications associated with Lyme disease. Patients have presented with conditions including paranoia, dementia, schizophrenia, bipolar disorder, panic attacks, major depression, anorexia nervosa, and obsessive-compulsive disorder. [3]

Dr. Robert Bransfield from Rutgers–Robert Wood Johnson Medical School has similarly described how Lyme disease may contribute to psychiatric symptoms.

“Lyme borreliosis causes immune and metabolic effects that result in a gradually developing spectrum of neuropsychiatric symptoms,” writes Bransfield. These symptoms may include depression, anxiety disorders, panic disorder, post-traumatic stress symptoms, sleep disorders, addiction, cognitive impairments, dementia, seizure disorders, and other behavioral disturbances. [4]

Lyme disease physical health

The list of physical health conditions associated with Lyme disease continues to grow as research advances. Reported complications include:

Lyme encephalopathy [5]
Lyme neuropathy [6]
Lyme carditis [7]
Autonomic dysfunction including postural orthostatic tachycardia syndrome (POTS) [8]
Post-treatment Lyme fatigue [9]
Neuropathic pain [10]
Persistent symptoms following Lyme disease [11]
Lyme disease with coinfections such as Babesia [12]

Perspective

The mental and physical health concerns experienced by Lyme disease patients remain incompletely understood. Nevertheless, these concerns deserve careful attention—particularly during the COVID-19 pandemic.

Lyme disease patients frequently report symptoms that overlap with those described in COVID-19, including fatigue, cognitive changes, mood disturbances, and other neurologic complaints.

Clinicians should be aware that patients with Lyme disease may experience mental health symptoms similar to those observed in COVID-19. These overlapping symptoms should not lead clinicians to automatically dismiss Lyme disease when evaluating patients during the pandemic.

Chronic manifestations of COVID-19: Lessons from Lyme disease?

16-year-old boy with Lyme disease presenting as depression

Oppositional behavior in children with Lyme disease

References:

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 clinical practice. Healthcare (Basel). 2018;6(3).
Fallon BA et al. Randomized trial of IV antibiotics for Lyme encephalopathy. Neurology. 2008;70(13):992-1003.
Halperin JJ et al. Lyme disease: cause of treatable peripheral neuropathy. Neurology. 1987;37(11):1700-1706.
Muehlenbachs A et al. Cardiac tropism of Borrelia burgdorferi. Am J Pathol. 2016;186(5):1195-1205.
Kanjwal K et al. Postural orthostatic tachycardia syndrome following Lyme disease. Cardiol J. 2011;18(1):63-66.
Krupp LB et al. Study and treatment of post-Lyme disease (STOP-LD). Neurology. 2003;60(12):1923-1930.
Simons LE. Fear of pain in children with neuropathic pain. Pain. 2016;157 Suppl 1:S90-97.
Klempner MS et al. Antibiotic treatment trials for persistent Lyme symptoms. N Engl J Med. 2001;345(2):85-92.
Krause PJ et al. Concurrent Lyme disease and babesiosis. JAMA. 1996;275(21):1657-1660.