Neuropsychiatric Lyme Disease: Depression, Rage, and Suicide Risk

Psychiatric symptoms have been reported in Lyme disease.
Researchers describe depression, rage, and sleep disruption.
Neuroinflammation may play a role.

By Daniel J. Cameron, MD, MPH

Neuropsychiatric symptoms associated with Lyme disease have been described in the medical literature for decades. Researchers have reported mood changes, irritability, cognitive dysfunction, sleep disturbances, anxiety, depression, and—in some cases—suicidal thoughts or behaviors.

These reports remain controversial, but they continue to raise important questions regarding neuroinflammation, immune dysfunction, and the neurologic impact of tick-borne illnesses.

---

Early Reports of Rage and Personality Changes

In a 1990 report, Logigian and colleagues from Tufts University School of Medicine described rage and behavioral changes in patients with chronic neurologic Lyme disease. [1]

“Eight patients had excessive daytime sleepiness, and seven had extreme irritability. They became angry over circumstances that previously caused only minor annoyance.”

The authors also described chronic neurologic symptoms affecting cognition, mood, and daily functioning. [1]

---

Psychiatric Symptoms Reported in Lyme Disease

In 1994, Fallon and Nields from Columbia University’s Department of Psychiatry reviewed neuropsychiatric complications associated with Lyme disease. [2]

The authors reported patients exhibiting:

• Paranoia
• Dementia
• Schizophrenia-like symptoms
• Bipolar disorder
• Panic attacks
• Major depression
• Obsessive-compulsive disorder

These findings helped expand discussion surrounding neuropsychiatric Lyme disease and its potential overlap with primary psychiatric disorders.

---

Bransfield’s Findings on Suicide Risk

More recently, psychiatrist Robert Bransfield from Rutgers Robert Wood Johnson Medical School reported observing suicidal and homicidal behaviors in some patients with Lyme disease and associated tick-borne illnesses. [3]

In his analysis of 253 patients:

• 43% were suicidal;
• 32% were suicidal, but not homicidal;
• 11% were both suicidal and homicidal;
• None were homicidal without also being suicidal;
• 25% had explosive anger but were not homicidal or suicidal;
• 10% had preexisting depression;
• 97% reported depression after infection;
• Patients were ill an average of 8.4 years before diagnosis and treatment.

In his article “Suicide and Lyme and Associated Diseases,” Bransfield described patients exhibiting a broad range of psychiatric symptoms including explosive anger, intrusive thoughts, paranoia, panic disorder, dissociative episodes, hallucinations, disinhibition, social anxiety disorder, chronic pain, depression, and posttraumatic stress disorder. [3]

---

Children With Chronic Lyme Disease and Suicidal Thoughts

Bransfield also cited a controlled study by Tager and colleagues examining cognitive deficits in children with chronic Lyme disease. [4]

“41% of children who had been diagnosed with Lyme disease had suicidal thoughts and 11% had made suicidal gestures.”

These findings underscore the importance of recognizing neurologic and psychiatric symptoms in children with persistent illness.

---

Can Infections Trigger Psychiatric Symptoms?

Researchers have increasingly examined how infections and inflammation may contribute to psychiatric symptoms in susceptible individuals.

Bransfield explains that chronic infections, inflammatory cytokines, metabolic changes, and neural circuit dysfunction may contribute to suicidal behavior in some patients. [3]

Sleep disruption, autonomic dysfunction, chronic pain, and neuroinflammation may overlap in some patients with neurologic Lyme disease.

The relationship between infection, neuroinflammation, immune dysfunction, and psychiatric symptoms remains an active area of investigation.

To learn more, see brain fog and Lyme disease and autonomic dysfunction in Lyme disease.

---

Why Recognition Matters

Bransfield estimated that approximately 1,200 suicides per year in the United States may involve Lyme disease and associated illnesses. [3]

He also warned that dismissal of symptoms by family members, friends, or healthcare professionals may contribute to emotional distress and suicide risk.

There is currently no national database tracking suicide or suicide attempts associated with tick-borne illnesses.

The author suggested that medical examiners, epidemiologists, and public health agencies further investigate possible associations between Lyme disease and suicide risk. [3]

---

Clinical Perspective

Neuropsychiatric symptoms in Lyme disease remain controversial and are often multifactorial. Not every psychiatric symptom in a patient with Lyme disease is necessarily caused by infection.

At the same time, growing research continues to examine how neuroinflammation, immune activation, sleep disruption, chronic pain, autonomic dysfunction, and prolonged illness may affect mental health.

Recognition, careful evaluation, and appropriate mental health support remain essential for patients experiencing severe neuropsychiatric symptoms.

If you or someone you know is experiencing suicidal thoughts or emotional distress, seek immediate medical attention or contact the 988 Suicide & Crisis Lifeline by calling or texting 988 in the United States.

---

Frequently Asked Questions

Can Lyme disease cause depression?

Some studies have reported depression and mood changes in patients with neurologic Lyme disease, although the relationship remains controversial and may involve multiple contributing factors.

What psychiatric symptoms have been reported in Lyme disease?

Researchers have described anxiety, irritability, panic attacks, cognitive dysfunction, depression, psychosis-like symptoms, sleep disturbances, and mood changes in some patients.

Can children with Lyme disease experience psychiatric symptoms?

Yes. Some studies have described cognitive symptoms, mood changes, and suicidal thoughts in children with chronic Lyme disease. [4]

---

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