Lyme disease can produce psychiatric symptoms so severe that patients are diagnosed with depression, anxiety, psychosis, or conversion disorder — and never tested for infection. Some are told their symptoms are stress. Others are told they’re seeking attention. By the time the underlying cause is identified, years of misdiagnosis may have passed.

Psychiatric Lyme disease is not a separate condition. It is what happens when Borrelia burgdorferi and other tick-borne infections reach the central nervous system — producing symptoms that look psychiatric but are driven by neuroinflammation.

What Psychiatric Lyme Disease Looks Like

The range of psychiatric symptoms associated with Lyme disease is broad and often overlapping. Patients may experience depression that appears suddenly and resists standard antidepressants. Anxiety and panic attacks may develop without prior history. Irritability, rage episodes, emotional lability, and personality changes can emerge in both adults and children.

More severe presentations include psychosis, paranoia, hallucinations, seizures, and altered mental status. Cognitive impairments — difficulty with attention, memory, processing speed, and executive function — are common and frequently overlap with what patients describe as brain fog.

Bartonella, a common tick-borne co-infection, has been specifically associated with psychiatric presentations including sudden-onset rage, anxiety, and psychotic features.

Why Psychiatric Symptoms Get Misdiagnosed

Psychiatric Lyme disease is missed because the symptoms look like primary mental illness. There is no standard protocol for testing Lyme disease in patients presenting with psychiatric complaints — even in endemic areas. Clinicians evaluating depression, anxiety, or psychosis rarely consider an infectious cause.

Bransfield describes two cases that illustrate this pattern. A healthy 18-year-old martial arts athlete developed a bull’s-eye rash followed by Bell’s palsy. Over four years, she became increasingly disabled and was eventually confined to a wheelchair with seizures, cognitive impairment, neuropathy, and generalized pain. Clinicians diagnosed her with fibromyalgia, chronic fatigue syndrome, and “wanting attention” rather than Lyme disease.

A 12-year-old girl from England presented with excruciating headaches, loss of balance, and involuntary jerking movements. One clinician described her condition as “hysteria, possible conversion disorder.” She was left deteriorating and untreated until seizures became constant and she required a wheelchair. Her family had repeatedly asked doctors to consider Lyme disease.

Both children improved with antibiotic treatment. The 18-year-old is now physically active, married, and leading a productive life. The 12-year-old’s seizures stopped within 36 hours of IV antibiotics, and she was walking again within two months.

The Labeling Problem

Bransfield writes that some healthcare providers have great difficulty understanding and making an accurate diagnosis when multisystemic symptoms are present — and categorize them as “vague” or “subjective” rather than medically valid.

Patients may be labeled as hypochondriacs, given a diagnosis of somatic symptom disorder, or referred to a psychiatrist when the underlying cause is infection. Historically, there has been a tendency to label physical symptoms that cannot be explained as being psychiatric in origin — until the disease is better understood.

This pattern of medical dismissal delays diagnosis and treatment, and in some cases causes irreversible harm.

How Lyme Disease Causes Psychiatric Symptoms

Borrelia burgdorferi can cross the blood-brain barrier and disseminate to the central nervous system within weeks of infection. Once in the CNS, the bacterium triggers neuroinflammation — disrupting neurotransmitter signaling, damaging neural tissue, and activating immune cascades that produce psychiatric symptoms.

The mechanism explains why symptoms can appear weeks, months, or even years after the initial infection — and why they often fluctuate rather than follow the steady progression typical of primary psychiatric disorders. Co-infections including Bartonella and Babesia can amplify neuropsychiatric presentations.

Autonomic dysfunction compounds the picture, producing anxiety-like symptoms including racing heart, dizziness, and panic that are physiologic rather than psychological.

Depression and Lyme Disease

Depression is one of the most common psychiatric manifestations of Lyme disease. It may appear suddenly in patients with no prior psychiatric history, resist standard antidepressant treatment, and improve with antibiotic therapy — a pattern that distinguishes infection-driven depression from primary mood disorders.

Clinicians should be cautious about confusing somatic symptoms with depression in early Lyme disease. Fatigue, sleep disruption, and cognitive difficulty can mimic depression even when mood is not the primary driver.

Children and Adolescents

Psychiatric presentations of Lyme disease in children can include sudden behavioral changes, school refusal, emotional volatility, seizures, and cognitive decline. A 16-year-old boy presenting with depression was ultimately found to have Lyme disease — a reminder that psychiatric symptoms in young people from endemic areas deserve screening for tick-borne infection.

The two children in the Bransfield cases were both confined to wheelchairs before receiving a correct diagnosis. Their recoveries after treatment underscore the stakes of missed psychiatric Lyme disease in pediatric patients.

Clinical Perspective

Psychiatric Lyme disease is not rare — it is underrecognized. When depression, anxiety, psychosis, seizures, or personality changes appear in a patient with a history of tick exposure, outdoor activity in endemic areas, or concurrent symptoms such as fatigue, pain, and cognitive difficulty, the possibility of tick-borne infection deserves evaluation.

Labeling patients as psychiatric before ruling out infection is not just a missed diagnosis — it is a missed opportunity to treat a condition that may be reversible. Both of the children Bransfield described recovered meaningful function once the correct diagnosis was made.

Frequently Asked Questions

Can Lyme disease cause psychiatric symptoms?
Yes. Lyme disease can cause depression, anxiety, psychosis, rage, personality changes, seizures, and cognitive impairment through neuroinflammation affecting the central nervous system.

Why are psychiatric symptoms from Lyme disease often missed?
Because the symptoms mimic primary mental illness. Clinicians evaluating psychiatric complaints rarely test for tick-borne infections, and patients may be diagnosed with conversion disorder, somatic symptom disorder, or “hysteria” before infection is considered.

Can Bartonella cause psychiatric symptoms?
Yes. Bartonella, a common tick-borne co-infection, has been associated with sudden-onset rage, anxiety, agitation, and psychotic features.

Do psychiatric symptoms from Lyme disease improve with treatment?
In many cases, yes. Depression, anxiety, seizures, and cognitive symptoms have been shown to improve — and in some cases fully resolve — with appropriate antibiotic treatment targeting the underlying infection.

Should patients with new psychiatric symptoms be tested for Lyme disease?
In endemic areas, especially when psychiatric symptoms appear suddenly, resist standard treatment, or occur alongside systemic complaints like fatigue, joint pain, or neuropathy — testing for Lyme disease and co-infections is clinically warranted.

References

1. Bransfield RC, Friedman KJ. Differentiating psychosomatic, somatopsychic, multisystem illnesses and medical uncertainty. Healthcare. 2019;7(4):114.
2. Fallon BA, Nields JA. Lyme disease: a neuropsychiatric illness. Am J Psychiatry. 1994;151(11):1571–1583.
3. Bransfield RC. Neuropsychiatric Lyme borreliosis: an overview with a focus on a specialty psychiatrist’s clinical practice. Healthcare. 2018;6(3):104.

Related Reading

• Depression and Lyme Disease
• Bartonella-Associated Psychiatric Symptoms
• Lyme Disease: “You Need to See a Psychiatrist”
• Seizures and Altered Mental Status After a Tick Bite
• Lyme Disease, Brain Fog, and Anxiety
• Lyme Disease and Mental Health
• Brain Fog and Lyme Disease
• Medical Dismissal and Lyme Disease