Neuropsychiatric Lyme Disease: Anxiety, OCD, Brain Fog, and More

Brain fog, anxiety, OCD symptoms, and mood changes may occur with neurologic Lyme disease
Neuropsychiatric symptoms can overlap with many medical and psychiatric conditions
Recognizing these symptoms early may help reduce delays in evaluation and care

Neuropsychiatric Lyme disease refers to cognitive, behavioral, emotional, and psychiatric symptoms that may occur alongside neurologic manifestations of Lyme disease. Patients often describe difficulties with concentration, memory, mood, sleep, and daily functioning, although these symptoms are not unique to Lyme disease.

Because these symptoms overlap with primary psychiatric disorders, autoimmune diseases, autonomic dysfunction, endocrine disorders, medication effects, sleep disorders, and other neurologic illnesses, determining the underlying cause can be difficult. In some patients, however, neuropsychiatric symptoms become a prominent part of the overall illness.

Earlier reviews by Fallon and Nields described Lyme disease as a multisystem illness that can involve the central nervous system and produce neurologic and psychiatric symptoms. More recent reviews continue to describe cognitive problems, mood symptoms, anxiety, depression, and rare severe psychiatric presentations in some patients with Lyme disease.

Research and clinical experience suggest that recognizing these symptoms early may reduce delays in diagnosis while ensuring that other neurologic, psychiatric, infectious, autoimmune, and metabolic conditions are appropriately evaluated.

Common Neuropsychiatric Lyme Symptoms

Patients with neuropsychiatric Lyme disease may experience symptoms affecting cognition, mood, behavior, and emotional regulation. Symptoms often fluctuate over time and vary considerably from one patient to another.

• Brain fog and slowed thinking
• Difficulty concentrating
• Memory problems
• Word-finding difficulty
• Anxiety or panic attacks
• Obsessive thoughts or OCD symptoms
• Depression or low mood
• Irritability and mood swings
• Emotional dysregulation
• Intrusive thoughts
• Sensory sensitivity to light, sound, or touch
• Sleep disturbances
• Depersonalization or derealization
• Behavioral or personality changes

Many of these symptoms overlap with autonomic dysfunction, chronic pain syndromes, sleep disorders, endocrine disease, medication side effects, and co-infections, making careful evaluation essential.

Brain Fog and Cognitive Symptoms

Cognitive dysfunction is among the most frequently reported neurologic complaints in patients with Lyme disease. Many describe these changes as brain fog, although the severity varies widely.

Common cognitive symptoms include:

• Difficulty concentrating
• Short-term memory problems
• Slower information processing
• Word-finding difficulty
• Trouble multitasking
• Reduced mental stamina
• Difficulty completing familiar tasks

Some patients experience only mild forgetfulness, while others report symptoms significant enough to interfere with work, school, or daily activities. Fatigue, poor sleep, chronic pain, autonomic dysfunction, depression, anxiety, medication effects, and other medical conditions can all contribute to cognitive impairment and should be considered during evaluation.

Because brain fog is nonspecific, clinicians typically evaluate for multiple contributing factors rather than attributing symptoms to a single cause.

Can Lyme Disease Cause Anxiety or Panic Attacks?

Some patients report new-onset anxiety, panic attacks, internal tremors, palpitations, dizziness, chest discomfort, or feelings of impending doom during Lyme disease. These symptoms may occur alone or alongside neurologic complaints such as brain fog, headaches, fatigue, and autonomic dysfunction.

Because anxiety is common in the general population, these symptoms should not automatically be attributed to Lyme disease. Clinicians typically consider a broad differential diagnosis, including primary anxiety disorders, autonomic dysfunction (including POTS), endocrine disorders, medication effects, sleep disorders, and other neurologic conditions.

Patients with orthostatic intolerance frequently describe symptoms that closely resemble panic attacks, including rapid heartbeat, sweating, lightheadedness, tremulousness, and shortness of breath. Identifying autonomic dysfunction may help explain symptoms that initially appear psychiatric.

Obsessive Thoughts, OCD Symptoms, and Behavioral Changes

Obsessive thoughts, compulsive behaviors, intrusive thoughts, emotional dysregulation, and sensory sensitivities have been reported in some patients with neuropsychiatric Lyme disease.

Behavioral symptoms may include:

• Obsessive-compulsive symptoms
• Intrusive thoughts
• Irritability
• Mood swings
• Emotional lability
• Sleep disruption
• Sensory overload
• Difficulty regulating emotions

Children and adolescents may present differently from adults and sometimes develop abrupt behavioral or cognitive changes. Because obsessive-compulsive symptoms have many potential causes, a comprehensive medical and psychiatric evaluation remains important.

Can Lyme Disease Cause Personality Changes?

Family members occasionally report that a loved one seems “like a different person” during illness. Patients may describe increased irritability, emotional lability, withdrawal, reduced frustration tolerance, or decreased motivation.

These changes are nonspecific and may also occur with chronic pain, sleep deprivation, depression, anxiety, medications, traumatic brain injury, autoimmune disorders, endocrine disease, or other neurologic illnesses. Careful evaluation helps determine which factors may be contributing.

Psychosis and Severe Neuropsychiatric Symptoms

Psychosis is uncommon, but psychiatric symptoms including paranoia, hallucinations, mood changes, panic attacks, depression, and obsessive-compulsive symptoms have been described in reviews of neuropsychiatric Lyme disease.

Published reviews and case reports have described patients presenting with severe psychiatric manifestations during Lyme neuroborreliosis. These reports do not establish that Lyme disease is the cause in every patient with psychiatric symptoms, but they illustrate why Lyme disease may be considered in the differential diagnosis when compatible neurologic symptoms, epidemiologic risk factors, and supporting clinical findings are present.

Case Reports Highlight Diagnostic Challenges

Bransfield and colleagues described two young patients with complex multisystem illness whose symptoms were initially dismissed as psychiatric or functional disorders before Lyme disease and other contributing medical conditions were recognized.

From martial arts athlete to wheelchair-bound

The first patient was a previously healthy 18-year-old competitive Taekwondo athlete who developed a bull’s-eye rash followed by Bell’s palsy. Over the next four years, she became progressively disabled and eventually required a wheelchair.

Her symptoms included:

• Brain fog and cognitive impairment
• Attention and memory problems
• Complex partial seizures
• Orthostatic hypotension
• Peripheral neuropathy
• Muscle atrophy
• Hair loss
• Pelvic pain
• Generalized pain
• Headaches
• Tactile hypersensitivity
• Sun sensitivity
• Weight loss
• Non-restorative sleep

She was initially diagnosed with fibromyalgia, chronic fatigue syndrome, hypoglycemia, “wanting attention,” and pseudoseizures before clinicians ultimately diagnosed late Lyme borreliosis together with several additional medical conditions contributing to her illness.

Following treatment, Bransfield reported that she recovered sufficiently to become physically active, marry, and resume a productive life.

From “hysteria” to encephalitis

The second case involved a 12-year-old girl from England who initially presented with leg pain before developing severe headaches, loss of balance, involuntary movements, and recurrent seizures.

One evaluation labeled her illness as possible hysteria or conversion disorder despite repeated requests from her family to consider Lyme disease because they lived in an endemic area and multiple family members had previously been infected.

She was later transferred to another hospital where physicians diagnosed encephalitis and possible encephalomyelitis related to Lyme disease. After beginning intravenous antibiotics, her seizures stopped within 36 hours and her headaches improved. Following two months of treatment she regained the ability to walk, although delayed diagnosis contributed to persistent symptoms requiring ongoing care.

Why Neuropsychiatric Lyme Disease Is Often Missed

Neuropsychiatric symptoms frequently overlap with primary psychiatric illness, autoimmune disease, chronic fatigue syndromes, endocrine disorders, autonomic dysfunction, medication effects, sleep disorders, and other neurologic diseases.

When anxiety, depression, insomnia, panic attacks, brain fog, or behavioral symptoms dominate the clinical picture, tick-borne illness may not be considered early, particularly when classic Lyme disease features are absent.

As Bransfield noted, patients with complex multisystem illness may undergo years of evaluation before an underlying medical explanation is recognized. These experiences highlight the importance of maintaining a broad differential diagnosis while carefully evaluating both psychiatric and medical causes of symptoms.

FAQ

Can Lyme disease cause anxiety?

Some patients with Lyme disease report anxiety, panic attacks, internal tremors, palpitations, and feelings of impending doom. Because these symptoms have many possible causes, clinicians typically evaluate for neurologic, psychiatric, autonomic, endocrine, medication-related, and sleep-related conditions before determining the underlying cause.

Can Lyme disease cause OCD symptoms?

Obsessive thoughts and compulsive behaviors have been described in some patients with neuropsychiatric Lyme disease. These symptoms are nonspecific and should prompt a comprehensive medical and psychiatric evaluation.

Can Lyme disease cause psychosis?

Psychosis is an uncommon manifestation but has been described in published case reports and reviews of Lyme neuroborreliosis. Because psychosis has many potential medical and psychiatric causes, careful evaluation is essential before attributing symptoms to Lyme disease.

Can Lyme disease cause brain fog?

Brain fog is one of the most frequently reported neurologic symptoms. Patients commonly describe problems with concentration, memory, word finding, multitasking, and slowed processing speed.

Can Lyme disease change your personality?

Some patients and family members report increased irritability, emotional lability, mood changes, or withdrawal during illness. These symptoms may have multiple contributing causes and warrant a comprehensive medical evaluation.

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Clinical Perspective

Neuropsychiatric symptoms can be among the most disruptive manifestations reported by patients with Lyme disease. Anxiety, cognitive dysfunction, behavioral changes, sleep disturbance, and mood symptoms frequently overlap with neurologic, autonomic, endocrine, psychiatric, and medication-related conditions. A careful history, neurologic examination, psychiatric assessment when appropriate, and evaluation for alternative diagnoses are important to guide management.

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Clinical Takeaway

Neuropsychiatric Lyme disease may include brain fog, anxiety, panic attacks, OCD symptoms, depression, mood changes, behavioral changes, and, rarely, psychosis. Because these symptoms overlap with many medical and psychiatric disorders, recognizing the broader clinical picture may help reduce delays in diagnosis while ensuring patients receive a thorough evaluation.

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Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention