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.

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.

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

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.

Clinical Perspective

Psychiatric Lyme disease is not rare — it is underrecognized. When depression, anxiety, psychosis, or personality changes appear in a patient with tick exposure or outdoor activity in endemic areas, 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.

Frequently Asked Questions

Can Lyme disease cause psychiatric symptoms?
Yes. Lyme disease can cause depression, anxiety, panic attacks, rage episodes, psychosis, paranoia, hallucinations, and personality changes through neuroinflammation affecting the central nervous system.

Why are psychiatric symptoms from Lyme disease often missed?
The symptoms closely resemble primary mental illness, and there’s no standard protocol for testing Lyme disease in patients presenting with psychiatric complaints, even in endemic areas.

Can Bartonella cause psychiatric symptoms?
Yes. Bartonella, a common tick-borne co-infection, is specifically associated with sudden-onset rage, anxiety, psychotic features, and other psychiatric presentations.

Do psychiatric symptoms from Lyme disease improve with treatment?
Yes. Many patients experience significant improvement in psychiatric symptoms when underlying Lyme infection is treated with appropriate antibiotic therapy, though recovery time varies.

Should patients with new psychiatric symptoms be tested for Lyme disease?
Testing should be considered when psychiatric symptoms appear suddenly, occur in endemic areas, include concurrent physical symptoms like fatigue or pain, or resist standard psychiatric treatment.

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

• Lyme Disease Misdiagnosis: Why It Happens and What Patients Need to Know
• Lyme Disease Depression: When Infection Looks Like Mental Illness
• Bartonella Psychiatric Symptoms: When Antibiotics Work Better
• Lyme Red Flag: “You Need to See a Psychiatrist”
• Lyme Brain Fog and Anxiety