Lyme disease psychiatric symptoms are frequently mistaken for primary mental illness. This case illustrates how one patient’s anxiety, rage, OCD, and depression were traced back to an undiagnosed tick-borne infection—and how treatment changed everything.

She came to me after eight months of worsening 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.

Recognizing Lyme Disease Psychiatric Symptoms Alongside Physical Signs

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 with Lyme disease psychiatric symptoms, rather than classic joint or flu-like presentations.

A Turning Point When Lyme Disease Was Considered

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 Lyme Disease Psychiatric Symptoms Are Often Missed

This case highlights an important and often overlooked reality: Lyme disease can affect the brain as profoundly as it affects the body.

Neuropsychiatric manifestations of Lyme disease have been well described in the medical literature, including mood changes, cognitive impairment, anxiety, and behavioral disturbances.

When psychiatric treatments fail to bring relief, clinicians should consider whether an underlying medical condition may be contributing. Lyme disease can trigger neuroinflammation, disrupt autonomic regulation, and alter neurotransmitter signaling—producing symptoms that closely resemble anxiety disorders, OCD, bipolar disorder, or depression.

Patients with Lyme disease psychiatric symptoms are frequently diagnosed with primary mental health disorders and treated exclusively with psychiatric medications. When the underlying infection or inflammatory process remains unrecognized, these treatments may offer limited benefit and deepen frustration.

This does not suggest that Lyme disease is the sole cause of psychiatric illness. Rather, it underscores the importance of considering medical contributors when symptoms are atypical, severe, or resistant to standard treatment.

The Importance of Looking Deeper

Lyme disease has long been called “the great imitator” because it can masquerade as autoimmune disease, chronic fatigue, neurologic disorders, or primary psychiatric illness.

When psychiatric symptoms coexist with cognitive changes, autonomic symptoms, or unexplained fatigue—and when standard treatments fail—it is worth asking whether Lyme disease could be contributing.

For this patient, identifying and addressing Lyme disease was life-changing. She moved from feeling trapped in an unrelenting cycle of psychiatric distress to regaining clarity and function.

This case reflects an individual patient experience and does not replace personalized medical assessment. However, it illustrates why clinicians must remain open-minded when evaluating psychiatric symptoms that do not respond as expected. Recognizing Lyme disease psychiatric symptoms can be the turning point toward meaningful recovery.

Resources

Healthcare. Bransfield RC. Neuropsychiatric Lyme borreliosis: an overview with a focus on a specialty psychiatrist’s clinical practice.  2018.

American Journal of Psychiatry.  Fallon BA, Nields JA. Lyme disease: a neuropsychiatric illness. 1994.

Neurobiology. Fallon BA, Levin ES, Schweitzer PJ, Hardesty D. Inflammation and central nervous system Lyme disease.. 2010.

National Institute of Allergy and Infectious Diseases. Lyme disease research and neurologic manifestations.

LymeDisease.org. Education on neuropsychiatric and persistent Lyme symptoms.