When “It’s All in Your Head” Isn’t the Answer
It’s one of the most painful things a patient can hear — “You need to see a psychiatrist.”
For many living with undiagnosed Lyme disease, that sentence ends medical care when it should begin it.
A young woman in her early 30s came to me after months of worsening anxiety, panic attacks, and cognitive fog. Her infectious disease doctor looked at her normal labs and said, “You need to see a psychiatrist.” That moment ended her medical evaluation. No one asked about possible tick bites, low-grade fevers, or migrating pain she had been suffering with.
Psychiatric referral isn’t wrong — unless it replaces medical investigation.
When Lyme Is Misread as Mental Illness
According to a 2018 study published in Neuropsychiatric Disease and Treatment, Lyme disease can present with symptoms that often resemble a primary psychiatric illness. When this happens, Lyme is often misdiagnosed as mental illness, and the true underlying infection is overlooked.
Patients may develop:
• Anxiety
• Depression
• Panic attacks
• Paranoia
• Hallucinations
• Mood swings
• Irritability and Rage
• Brain Fog and Confusion
• Suicidality
Many of my patients often say being told that they needed to see a psychiatrist was the hardest moment — when their illness was seen as imaginary. But once diagnosed with Lyme disease and their infection and inflammation were treated, their thinking and mood often improved.
Many doctors don’t realize these mental symptoms often come with physical ones too — tiredness, aching joints, and fevers.
But when labs come back “normal,” the physical complaints get reframed as psychosomatic, and the psychiatric label becomes the only diagnosis.
These experiences aren’t rare — and they’re not imagined. Research over the past three decades shows that infection-driven brain inflammation can profoundly affect mood and cognition, contributing to Lyme depression and anxiety that respond best when the underlying illness is addressed.
All too often physicians just don’t recognize how infection can mimic psychiatric disorders.
🧠 What the Research Shows: Columbia University
Neuropsychiatric Lyme disease can affect both mood and cognition in ways that resemble psychiatric illness, according to a study by Columbia University published in the Journal of Neuropsychiatry and Clinical Neurosciences (2001).
Dr. Brian Fallon’s clinical research found that patients with post-treatment Lyme disease syndrome (PTLDS) frequently experience brain fog, memory problems, depression, anxiety, and emotional changes that persist even after initial antibiotic therapy.
Fallon’s work was groundbreaking because it used objective imaging to demonstrate what patients had been reporting for years — that their symptoms had a biological foundation. He has long explained that these changes come from biological causes, not imagination, and that people often get better when infection and inflammation are treated — along with good medical and mental health support.
🧩 Insights from: Neuropsychiatrist and Lyme specialist
While Dr. Fallon focused on cognitive and mood changes, neuropsychiatrist Dr. Robert C. Bransfield has documented an even broader spectrum of psychiatric manifestations linked to Lyme and other tick-borne infections.
His research shows that inflammation and immune activation can trigger anxiety, panic attacks, obsessive thoughts, depression, irritability, and mood swings — often occurring alongside infection activity. In more advanced cases, he observed insomnia, vivid dreams, emotional blunting, social withdrawal, impulsivity, paranoia, and even hallucinations.
These symptoms frequently improve when infection and neuroinflammation are treated. Dr. Bransfield emphasizes that they are due to an underlying biological cause and NOT a primary psychiatric disorder. Prematurely labeling patients as “psychiatric” can delay proper treatment and recovery.
“Treat the infection and the mind begins to clear,” he writes — a reminder that psychiatry and infectious-disease medicine must work together, not apart.
I’ve personally seen this transformation — patients whose so-called “psychiatric illness” resolved dramatically once their Lyme was properly treated, sometimes within weeks of starting appropriate therapy.
A Better Way Forward
Psychiatric consultation isn’t inherently harmful — premature labeling is. Patients benefit most when medical and psychological care collaborate. But when physical symptoms are dismissed as “all in your head,” the result is delayed diagnosis and lost trust.
Clinicians should recognize that an infection with Borrelia burgdorferi (the causative agent of Lyme disease) or other tick-borne co-infections can impact not only the body but the brain, as well.
Patients need care that treats both, without stigma. If you’ve been told it’s “just anxiety” or “you need to see a psychiatrist” but feel something deeper is wrong, find a Lyme-literate doctor who can look at both your physical and emotional symptoms.
Have You Been Told to “See a Psychiatrist”?
💬 Have you been told “it’s just anxiety” or “you need a psychiatrist” when you suspected Lyme? Share what happened next — your experience could validate someone else’s struggle.
⚠️ Not medical advice. Always work with qualified healthcare professionals for both medical and mental-health evaluation.
References
Neuropsychiatric Disease and Treatment (2018) Aggressiveness, violence, homicidality, homicide, and Lyme disease
Healthcare (2018) Neuropsychiatric Lyme Borreliosis: An Overview with a Focus on a Specialty Psychiatrist’s Clinical Practice
Journal of Neuropsychiatry and Clinical Neurosciences (2001) A Controlled Study of Cognitive Deficits in Children With Chronic Lyme Disease
American Journal of Psychiatry (1994) Lyme disease: a neuropsychiatric illness
Dr. Daniel Cameron: Blog. Suicidal behaviors in patients with Lyme and associated disease
Dr. Daniel Cameron: Blog. Symptoms of Lyme disease are not “excessive”
