Lyme Disease Psychiatric Symptoms: Anxiety, Depression, and Treatment Options
Lyme disease psychiatric symptoms can include anxiety, depression, and even suicidal thoughts, complicating diagnosis and treatment. A case report highlights the challenges of evaluating a patient with neuropsychiatric symptoms and a history of Lyme disease. :contentReference[oaicite:0]{index=0}
In the article “New-onset Panic, Depression with Suicidal Thoughts and Somatic Symptoms in a Patient with a History of Lyme Disease”, Garakani and Mitton emphasize the complexity of managing patients with overlapping psychiatric and physical symptoms.
Case Presentation
A 37-year-old man presented with panic attacks, depression with suicidal thoughts, and somatic symptoms.
His symptoms included:
- Palpitations and chest pressure
- Tremulousness and choking sensation
- Fear of dying
- Fatigue and poor sleep
- Back pain, muscle spasms, and weakness
- Numbness and tingling in extremities
- Loss of appetite and weight loss
Despite treatment with antidepressants and anti-anxiety medications, his symptoms persisted.
History of Lyme Disease
The patient had a history of Lyme disease two years earlier, following a tick bite and flu-like illness.
Although initial treatment with doxycycline was completed, he continued to experience anxiety and neuromuscular symptoms.
Repeated evaluations, including Western blot testing, were negative.
Persistent Symptoms and Psychiatric Admission
The patient was admitted for inpatient psychiatric care due to worsening depression and suicidal thoughts.
Even after treatment, he continued to experience:
- Fatigue and weakness
- Pain and spasms
- Cognitive impairment and forgetfulness
- Poor attention and concentration
These persistent symptoms contributed to frustration and hopelessness.
Alternative Diagnosis and Treatment
Further evaluation at a specialty laboratory revealed evidence of Borrelia infection and Babesia coinfection.
After six months of antibiotic therapy—including tetracycline, azithromycin, and fluconazole—his cognitive symptoms improved.
Notably, his panic attacks and suicidal thoughts resolved, and psychiatric medications were discontinued.
Missed Treatment Considerations
The case raises important questions about treatment decisions.
The authors did not fully address:
- The role of retreatment for persistent infection
- The significance of Western blot bands 31 and 34
- The impact of Babesia coinfection
- The limitations of current diagnostic criteria
They also did not explore additional options such as intravenous antibiotic therapy, which may be necessary in cases involving neurologic Lyme disease.
Role of Coinfections
Babesia coinfection can increase disease severity and prolong recovery.
Studies have shown that coinfected patients are more likely to experience fatigue, headaches, sweats, chills, and emotional symptoms.
Treatment often requires combination therapy, such as azithromycin and atovaquone.
Neuropsychiatric Lyme Disease
Borrelia burgdorferi can cross the blood-brain barrier, leading to chronic neurologic Lyme disease and Lyme encephalopathy.
Intravenous ceftriaxone has been effective in treating these conditions by targeting infection within the central nervous system.
Clinical Perspective
This case illustrates the complexity of Lyme disease psychiatric symptoms and the need for a multidisciplinary approach.
Patients with psychiatric symptoms and a history of Lyme disease should be evaluated for persistent infection and coinfections, alongside appropriate psychiatric care.
A combined approach—including antimicrobial therapy and supportive treatments such as cognitive behavioral therapy—may offer the best outcomes.
References
- Garakani A, Mitton AG. Case Rep Psychiatry, 2015.
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
My husband was diagnosed with Lyme and Babesia about 9 years ago. He has been undergoing treatment ever since. He changed providers last year and his new provider wants him to be re-tested by Igenex. I’m concerned that if the tests are only IGG positive she will not continue to treat him. Are you aware of any methods to “provoke” activity to get a positive (IGM) result? Thank you!
I don’t have a way to provoke an IgM. Some doctors dismiss the IgM if someone has been ill for more than a month. Your doctor will have to use clinical judgment at the Igg stays positive even if the infection has resolved. Call my office at 914 666 4665 if you have any questions.
My 28 year old daughter is having panic attacks almost daily. She experienced childhood trauma and was also diagnosed with Lyme disease in 2015 but is not able to complete treatment due to the onset of anxiety and panic around treatments and her physical symptoms. Can you recommend an inpatient treatment center that can address both the mental/emotional and physical issues?
I work with complex presentations in my practice. I understand how hard it is to find the right in-patient program. I don’t know of any programs. I have patients that have had an in patients experience but they have found it difficult to find a doctor with experience treating Lyme disease with psychiatric issues.
Dr Cameron,
Thank you for what you do for the Lyme community! I was diagnosed with Babesia Duncani and Lyme by IGENEX labs in Feb 2020. I started treatement the first week of March with DOXY Azithromycin Ceftin and Mepron. My symptoms felt more neurological in June and my LLMD tested me for BART through Galaxy and I was PCR positive. We then stopped my babesia treatment and focused my regiment on Bart and I tested clear of BART in August and September through IGENEX W-Blot, Galxay tripple draw, and T-lab. However My babisia titer was higher than in Feb (340). I was feeling good through September- October so I was taken off antibiotics. In late October I started to develop that odd neurological anxiety. My symptoms now are anxiety, shortness of breath, slight heart palpitations, depression, neurological slight cognitive impairment. My LLMD thinks that I have lyme or BART persisters and is putting me on Horowitz’s Double Dapsone protocol. (Dapsone build to 200MG a day, Minocycline, Bacrtrim DS, Oregano oil, AlliMax, and I will take 50mg of Methylene blue a day for the last 4 weeks of treatment). My question, Will this treatment also address my Babesia Duncani? Should I address Babesia prior to heavy Bart and Lyme protocol?
I do not believe your proposed combination works for Babesia. I typically return to Babesia before the new protocol. Other doctor disagree.
Caught Lyme on east coast 2009. Was prescribed 10 days of doxycycline right when I found the bullseye. (4 days after tick removal). Physical symptoms went away within 2 weeks. A year later, came down with OCD symptoms (first time ever- I was 43 years old). Had a death in the family during that year as well and attributed OCD to that. But wonder if it could be Lyme. Last Lyme test I had was in 2015 I believe and it was still showing positive for IgM but not IgG. (So looks like recent infection in my blood work). Could Lyme be causing my mental health issues or just coincidence? Therapy has helped some, SSRIs made me worse, but a decade later, I’m miserable emotionally. Doctors just chalk it up to emotional trauma but I can’t understand why I can’t seem to get better., and why such a late onset in life. I don’t have any physical symptoms.
I don’t know where to turn. I live in the Midwest so very few deal with Lyme much. I tried someone in Maryland and they just said “well sometimes you don’t seroconvert, keep an eye on your heart just in case”. Another doctor asked if maybe I had syphilis. (That one cracked me up. I know you can get a false positive for Lyme with syphilis, but I found it funny).
Any advice would be so appreciated.
I find it difficult to determine if a tick-borne illness is part of the problem. The tests are not as reliable as I would like. An IgM western blot test can come and go in some patients without ever developing an IgG western blot test. I advise my patients to continue their psychiatric care while looking a second time at a tick borne illness.
Tet books from Dr. Jay Davidson, Dr. Horowitz. Lookup Dr Buhner, join fb group “Microbe Formulas Detox Heroes”. Join Mivrobe Forumulas website for a wealth of videos. For my daughter the physical healing began with functional medicine. Find a lyme literate medical doctor (LLMD) is another option
Hello
I received the 2nd moderna vaccine. The next morning I had a stiff neck and back and headaches. Also, a lot of anxiety. I was treated for lyme 5 years for over 2 years. My symptoms approved. Could the vaccine make my lyme symptoms reappear? Thank you
The symptoms following a COVID-19 can resemble symptoms of Lyme disease even in patients without a history of Lyme disease. I have patients and readers of my blog who are sharing their experience. It is hard to know what symptoms are from the COVID-19 vaccine or a flare-up of Lyme disease. Some Lyme disease patients face flare-ups with or without a vaccine. Many of my patients and readers have suffered from immune issues related to Lyme disease. My patients and readers are only making these tough decisions given the severity of COVID-19 in some individuals.
Hi Dr. Cameron,
My daughter suffered from Lyme’s disease and mononucleosis concurrently when she was in middle school. Approximately 2 years later, she developed sudden onset of severe anxiety and depression. Assay shows that she still has a few positive bands, which are not enough to warrant treatment according to her PCP. My daughter has now graduated high school and her psych symptoms are so severe that she cannot function at all. A friend of mine has a teenage daughter who experienced similar severe psychiatric symptoms after Lyme’s disease and mono on a similar timeline. Do you think there could be a relationship between Lymes/mono and psychiatric illness?
I have seen patients in my practice with the same presentations. Others have too. Here is a blog https://danielcameronmd.com/dont-be-mislead-patients-can-have-both-mono-and-lyme-disease/
The tests are not so reliable.
Hi Dr. Cameron,
My daughter suffered from Lyme’s disease and mononucleosis concurrently when she was in middle school. Approximately 2 years later, she developed sudden onset of severe anxiety and depression. Assay shows that she still has a few positive bands, which are not enough to warrant treatment according to her PCP. My daughter has now graduated high school and her psych symptoms are so severe that she cannot function at all. A friend of mine has a teenage daughter who experienced similar severe psychiatric symptoms after Lyme’s disease and mono on a similar timeline. Do you think there could be a relationship between Lymes/mono and psychiatric illness?