Neuropsychiatric Lyme Disease Treatment: A Case of Panic and Depression
Panic attacks, depression, and cognitive problems developed after Lyme disease
Psychiatric treatment provided incomplete relief
Panic attacks and cognitive symptoms improved after additional treatment
Neuropsychiatric symptoms reported in association with Lyme disease include panic attacks, anxiety, depression, cognitive difficulties, memory problems, sleep disruption, and suicidal thoughts. A published case illustrates the difficulty of determining whether new psychiatric symptoms represent a primary psychiatric disorder, consequences of chronic illness, persistent symptoms following Lyme disease, or another medical process.
In their article, “New-Onset Panic, Depression with Suicidal Thoughts, and Somatic Symptoms in a Patient with a History of Lyme Disease,” Garakani and Mitton describe a 37-year-old man whose previous Lyme disease complicated the evaluation and treatment of new psychiatric, cognitive, and physical symptoms.1
The authors emphasize the potential role of cognitive behavioral therapy in patients with chronic illness and mood symptoms. The case also raises broader questions about diagnostic framing, medical reassessment, possible tick-borne coinfections, and the role of antimicrobial treatment in selected patients with persistent symptoms.
Can Lyme disease be associated with panic attacks and depression?
Lyme disease has been reported in association with anxiety, panic attacks, depression, cognitive dysfunction, sleep disturbances, and other neuropsychiatric symptoms. However, these symptoms are not specific to Lyme disease and can have numerous infectious, inflammatory, neurologic, metabolic, medication-related, and psychiatric causes.
A history of Lyme disease does not establish that every subsequent psychiatric or cognitive symptom is caused by an active infection. At the same time, the emergence of psychiatric symptoms should not automatically prevent clinicians from investigating possible medical contributors—particularly when physical and neurologic symptoms are also present.
Panic attacks and depression following Lyme disease
Garakani and Mitton presented the case of a 37-year-old employed man who was admitted with new-onset panic attacks, severe depression, suicidal thoughts, and multiple physical complaints. He had no known history of a psychiatric disorder.
His panic symptoms included palpitations, tremulousness, chest pressure, choking sensations, and an intense fear of dying. He also reported back pain, muscle spasms, weakness and tingling in his extremities, generalized fatigue, poor sleep, low energy, diminished appetite, loss of interest in work and social activities, and a 10-pound weight loss.
His symptoms persisted despite two months of treatment with antidepressant and anti-anxiety medications.
Previous Lyme disease treatment
Two years earlier, the patient had reportedly experienced fatigue, tinnitus, headaches, fever, and flu-like symptoms approximately one month after removing a tick from his leg. His Lyme enzyme-linked immunosorbent assay was positive, and he was treated with doxycycline at 100 mg twice daily for three weeks.
Although his acute symptoms improved, anxiety and neuromuscular pain persisted. These continuing symptoms prompted multiple emergency department visits.
Psychiatric hospitalization and persistent cognitive symptoms
The patient was eventually admitted to an inpatient psychiatric unit because of depression and suicidal ideation. He was treated with antidepressants, anti-anxiety medications, and a beta-blocker.
His mood partially improved, but he continued to experience cramping, flank pain, fatigue, arthritic knee pain, anxiety, impaired attention, cognitive slowing, and panic symptoms.
Garakani and Mitton reported that he was “very forgetful at home.” He had difficulty remembering whether he had taken his medications and frequently could not recall where common household objects had been placed.
His persistent cognitive and physical symptoms contributed to frustration, hopelessness, and passive thoughts of dying.
If you or someone you know is experiencing suicidal thoughts or is in immediate danger, call emergency services or go to the nearest emergency department. In the United States, call or text 988 to reach the 988 Suicide & Crisis Lifeline.
Suicidal thoughts require prompt psychiatric evaluation. Investigation of possible infectious, neurologic, inflammatory, or other medical contributors should proceed alongside appropriate psychiatric care—not in place of it.
After eight days of hospitalization, he was discharged with continuing fatigue, weakness, back and leg spasms, shooting pains in his hands, and ascending paresthesias. Evaluations by multiple internists and neurologists did not identify another explanation, and subsequent standard Lyme Western blot testing was negative.
Suicidal thoughts always require prompt attention. Anyone in immediate danger or considering self-harm should seek emergency assistance immediately. Evaluation for possible infectious, neurologic, inflammatory, or other medical contributors should proceed alongside appropriate psychiatric care—not in place of it.
Attributing persistent physical and cognitive symptoms exclusively to a psychiatric diagnosis can lead to premature diagnostic closure. This concern is discussed further in Medical Dismissal in Chronic Lyme Disease.
Subsequent Lyme disease and coinfection evaluation
The patient continued seeking specialty care and was later diagnosed with suspected chronic Lyme disease following testing through IGeneX Laboratories. According to the case report, testing demonstrated reactivity to Borrelia burgdorferi proteins 31 and 34. These proteins were not included among the bands used in standard CDC surveillance interpretation.
The authors also reported that the patient had tested positive for Babesia, although the case report does not clearly identify the type of Babesia test or provide supporting clinical findings. The available information is therefore insufficient to determine whether he had active babesiosis or whether Babesia contributed to his symptoms.
The case illustrates an area of continuing controversy. The later diagnosis was based at least in part on specialty laboratory findings in a patient with persistent symptoms and negative standard Lyme testing. The report does not provide enough information to determine how the clinician weighed the patient’s history, symptoms, examination, and laboratory results.
Symptoms improved after additional treatment
The patient was treated for six months, consisting of three months of tetracycline followed by three months of azithromycin and fluconazole.
Following treatment, his cognitive difficulties improved, his panic attacks resolved, and his depressive symptoms diminished sufficiently for him to discontinue psychiatric medications.
Nevertheless, he continued to experience fatigue, weakness, low energy, and musculoskeletal pain. These residual symptoms prevented him from returning to work and resulted in a need for disability support.
The improvement following treatment is clinically noteworthy, but a single uncontrolled case cannot establish why the patient improved. The effects of treatment, the passage of time, psychiatric care, changes in medication, and other factors cannot be separated with certainty.
Questions raised by the case report
Garakani and Mitton provided a careful psychiatric analysis and acknowledged the controversy surrounding chronic Lyme disease. The case also raises several broader clinical questions:
- How should clinicians evaluate persistent psychiatric, cognitive, neurologic, and physical symptoms following standard Lyme disease treatment?
- When should negative standard Lyme testing be reconsidered in the context of a previous positive test and compatible clinical history?
- How should clinicians interpret nonstandard Western blot bands and specialty laboratory results?
- What evidence is needed before attributing persistent symptoms exclusively to psychological factors?
- When should patients be evaluated for Babesia or other tick-borne infections?
- Which patients, if any, may benefit from additional antimicrobial treatment?
Psychiatric care and medical reassessment are not mutually exclusive
Psychiatric and psychological care can be essential for patients experiencing panic, depression, suicidal thoughts, or the emotional consequences of chronic illness. Cognitive behavioral therapy, appropriate medication, and other forms of mental health support may improve symptoms and help patients cope with functional limitations.
These interventions should not prevent an appropriate medical evaluation when psychiatric symptoms occur alongside cognitive changes, neuropathic pain, profound fatigue, joint symptoms, or other physical findings.
In my clinical experience, some patients with a history of Lyme disease present with panic attacks, depression, cognitive difficulties, sleep problems, and otherwise unexplained physical symptoms. These observations do not establish that persistent infection is responsible in every case. They do support maintaining a broad differential diagnosis and avoiding premature conclusions.
Evaluation may need to consider previous Lyme disease, possible tick-borne coinfections, medication effects, endocrine or metabolic abnormalities, neurologic conditions, sleep disorders, primary psychiatric illness, and the psychological effects of prolonged physical symptoms.
Frequently Asked Questions
Can Lyme disease cause panic attacks?
Panic attacks have been reported in patients with Lyme disease, but they are not specific to the infection. Panic symptoms may have psychiatric, neurologic, cardiac, endocrine, medication-related, or other medical causes. A complete evaluation is important, especially when panic attacks develop alongside physical or cognitive symptoms.
Can Lyme disease be associated with depression?
Depression has been reported during and after Lyme disease. However, the relationship may be complex and can involve infection-related illness, inflammation, persistent physical symptoms, sleep disruption, functional loss, psychological distress, or an independent mood disorder.
What cognitive symptoms have been reported with Lyme disease?
Reported symptoms include impaired concentration, slowed information processing, short-term memory difficulties, word-finding problems, and mental fatigue. Patients often describe these difficulties collectively as brain fog, although that term is not a specific diagnosis.
Do psychiatric symptoms prove that Lyme disease has reached the brain?
No. Psychiatric symptoms alone do not prove central nervous system infection or neuroborreliosis. Diagnosis requires consideration of the complete clinical presentation, objective findings, testing, alternative explanations, and the limitations of available diagnostic methods.
Do negative Lyme blood tests exclude Lyme disease?
Negative testing can make Lyme disease less likely, but test interpretation depends on the timing of testing, prior treatment, the type of assay, and the clinical presentation. Laboratory testing should be interpreted as part of a broader medical evaluation rather than in isolation.
Should psychiatric treatment be delayed while Lyme disease is investigated?
No. Significant anxiety, depression, panic attacks, or suicidal thoughts should receive prompt psychiatric attention. Medical evaluation for possible infectious, neurologic, or other contributors can proceed at the same time.
Clinical Takeaway
This case demonstrates the difficulty of separating psychiatric illness, persistent symptoms following Lyme disease, possible coinfection, and the effects of chronic physical illness. The patient’s panic attacks, depression, and cognitive problems improved after additional treatment, while several disabling physical symptoms continued.
The outcome does not prove that active infection caused every symptom or that prolonged antimicrobial treatment will benefit other patients. It does show why clinicians should avoid treating psychiatric and medical explanations as mutually exclusive.
Patients with new psychiatric symptoms and persistent physical or cognitive problems deserve timely mental health support together with a careful, individualized medical evaluation.
This article discusses a published case for educational purposes and does not provide medical advice, diagnosis, or individualized treatment recommendations.
Related Articles
Neuropsychiatric Lyme disease: anxiety, OCD, and brain fog
Lyme disease symptoms guide
Persistent Lyme disease overview
Lyme disease coinfections
References
- Garakani A, Mitton AG. New-onset panic, depression with suicidal thoughts, and somatic symptoms in a patient with a history of Lyme disease. Case Reports in Psychiatry. 2015;2015:457947.
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
