Suicide Risk and Severe Psychiatric Symptoms in Lyme Disease

Lyme disease may affect both the brain and nervous system.
Some patients report severe psychiatric symptoms during illness.
Delayed diagnosis may worsen neuropsychiatric complications.

Welcome to another selection from my book “An Expert’s Guide on Navigating Lyme Disease.” This discussion reviews published findings and clinical observations involving suicidal thoughts, aggression, depression, and neuropsychiatric symptoms in Lyme disease and related tick-borne illnesses.

Dr. Robert Bransfield of Rutgers–Robert Wood Johnson Medical School, Department of Psychiatry, has described suicidal and homicidal concerns in patients with Lyme disease and related tick-borne illnesses.

Likewise, in my practice I have seen patients struggling with severe depression, anxiety, hopelessness, and suicidal thinking during the course of untreated or poorly recognized Lyme disease.

These psychiatric symptoms may occur alongside other Lyme disease symptoms, including fatigue, cognitive dysfunction, sleep disturbance, autonomic symptoms, and neurologic complaints.

Psychiatric Symptoms Reported in Lyme Disease

Lyme disease has been associated with a broad range of neuropsychiatric symptoms.

Reported symptoms may include:

• depression
• anxiety
• panic attacks
• cognitive impairment
• brain fog
• sleep disorders
• irritability
• rage episodes
• dissociation
• substance abuse
• suicidal thinking

These symptoms may occur in the setting of neurologic Lyme disease, immune dysregulation, chronic inflammation, sleep disruption, autonomic dysfunction, and prolonged untreated illness.

See also immune dysregulation and neuroinflammation in Lyme disease.

Dr. Robert Bransfield’s Observations

Dr. Robert Bransfield reported observing suicidal and homicidal concerns among patients with Lyme disease and related tick-borne illnesses.

In a group of 253 patients:

• 43% reported suicidal thoughts
• 32% were suicidal but not homicidal
• 11% were both suicidal and homicidal
• 25% experienced explosive anger without suicidality
• 10% had pre-existing depression
• 97% reported depression after infection

Patients were ill an average of 8.4 years before diagnosis and treatment. Read more.

Published Psychiatric Case Reports

Several published case reports have described severe psychiatric presentations associated with Lyme disease.

Three psychiatrists reported cases supporting Bransfield’s concerns (Munir et al., 2017).

“A 44-year-old male without any past psychiatric history presented with a third unsuccessful suicide attempt and was later diagnosed as having a Borrelia infection” (Bransfield, 2017).

After one month of intravenous ceftriaxone therapy, the patient experienced improvement in mental status and resolution of suicidal ideation (Banerjee 2013).

Dr. Brian Fallon described two similar cases in a 1995 report. One patient experienced severe suicidal thoughts and intrusive violent imagery, while another demonstrated violent and assaultive behavior.

Both patients improved following combined antibiotic and psychiatric treatment.

Read more.

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Case Report: Violence, Substance Abuse, and Suicide

An article titled “A Fatal Case of Late Stage Lyme Borreliosis and Substance Abuse” described a patient exhibiting aggressiveness, violence, and homicidal behavior.

Like many Lyme disease patients, the individual experienced delayed diagnosis and treatment.

Early Lyme disease testing may sometimes be negative, contributing to delays in recognition.

The patient’s illness progressed with worsening neurologic and psychiatric symptoms.

“Further disease progression contributed to him feeling desperate as a result of multiple late-stage symptoms,” wrote Bransfield and colleagues.

Several case reports describe tragic outcomes involving untreated or poorly recognized infection. See additional discussions of fatal Lyme disease cases.

Bransfield and colleagues emphasized that earlier diagnosis, treatment, and attention to substance abuse risk may help reduce psychiatric deterioration.

“More effective diagnosis and treatment and attention to substance abuse potential in these patients may help prevent some cases of addictive disorders, substance abuse, and death.”

Read more.

Why Neuropsychiatric Lyme Disease May Be Missed

Psychiatric symptoms may be attributed solely to primary mental health disorders when underlying infection is not considered.

Patients with Lyme disease may initially present with:

• anxiety
• panic symptoms
• fatigue
• sleep disturbance
• cognitive slowing
• mood instability
• autonomic symptoms

Without recognition of the broader multisystem pattern, the infectious component may be overlooked.

Psychiatric symptoms have also been described in other chronic infectious illnesses. See discussion of mental health in Lyme disease and COVID-19.

988 Suicide & Crisis Lifeline

The 988 Suicide & Crisis Lifeline provides free and confidential support for people experiencing emotional distress, suicidal thoughts, substance use crisis, or concern for a loved one.

Anyone in the United States can call or text 988 24 hours a day.

• mental health distress
• suicidal thoughts
• substance use crisis
• emotional crisis
• support for concerned family members

If you or someone you know is in immediate danger, call 911 or seek emergency medical assistance.

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