Is it possible that a tiny little tick could assault the brain and body and cause lingering mental health issues in its wake? Yes. But even with decades of research that demonstrates a causal link between infectious disease and psychiatric issues, our healthcare system still isn't appropriately identifying and treating those afflicted with Lyme disease. The real question is: why are we missing these individuals?
It isn't an easy answer. Ultimately the complexity of how the disease impacts the brain and body and how uniquely the symptoms can present is a major factor, as some show symptoms right away and delete others not until months or years later. A lack of definitive diagnostics is another factor in accurate identification. Lastly, a lack of acceptance of the disease and not enough Lyme-literate medical and mental health professionals is a hurdle in both diagnosis and treatment.
Research on Lyme Disease and Mental Health
Since the early 1990s, research has demonstrated a clear link between psychiatric conditions and Lyme disease, and continues to signify a connection. In 2002, Tomáš Hájek, MD and colleagues found that 33 percent of screened psychiatric patients showed signs of an infection with the Lyme spirochete, Borrelia burgdorferi. Many mental health issues have been linked to tick-borne bacteria, including: depression, mood lability, bipolar disorder, irritability, anxiety, panic attacks, obsessive compulsive disorder, attention and executive functioning problems, memory issues, word finding difficulties and even psychosis.
A 2018 study by Shreya Doshi, MA and colleagues found that in patients with post-treatment Lyme symptoms, they had depression symptoms 8 to 45 percent of the time, and suicidal ideation was reported by 19.8 percent of these patients. In 2017, Dr. Rosalie Greenberg's study found that 89 percent of participants diagnosed with Pediatric Bipolar Disorder tested positive to one or more pathogens, including tick-borne Babesia, Bartonella and Lyme, as well as Mycoplasma pneumoniae.
Even with many research studies over decades that demonstrate a causal link between infectious disease and mental health, the average person sees between five and seven doctors before a diagnosis of Lyme disease.
Lyme's Effect on the Brain
When Lyme disease affects the brain, it is frequently referred to as Lyme neuroborreliosis or Lyme encephalopathy. Neuroborreliosis is an infection within the brain that can mimic virtually any type of encephalopathy or psychiatric disorder and is often compared to neurosyphilis. Both are caused by spirochetes, are multi-systemic and can affect a patient neurologically, producing cognitive dysfunction (memory, word finding, attention problems) and organic psychiatric illness (anxiety, depression, OCD).
The causative agent of Lyme disease, Borrelia burgdorferi, is a highly neurotropic organism that not only can produce neurologic disease, but also can exist dormant within the central nervous system (CNS) for long periods—even months or years. It is an evolved pathogen that uses several strategies to survive in both human and animal hosts, including using a screw-like mechanism that allows the bacteria to embed in the cell's membrane.
There are multiple ways in which Lyme disease affects the brain and body and produces changes in the CNS that leads to mental health issues. The Lyme spirochete can burrow into the brain and nervous system, causing damage within the brain that leads to long-term issues. It causes brain swelling or inflammation that leads to psychiatric issues, causes immune reactions to the bacteria and impacts the endocrine system and hormones. Lyme can impact any area of the brain, including the emotional center of the brain: the limbic system. The bacteria in Lyme releases toxins in the brain and body, and these exotoxins are continuously released as waste material that may cause symptoms.
Why is Lyme Disease Hard to Identify?
Lyme disease is known as the great imitator because its symptoms mimic and overlap with so many other diseases that it can be hard to diagnose. It is a multi-systemic illness that can affect the CNS, causing a wide array of neurologic and psychiatric symptoms. In 1994, Fallon and Nields noted up to 40 percent of patients with Lyme disease develop neurologic involvement of either the peripheral or central nervous system.
Most people don't realize that there are three stages of Lyme disease: early with dermatological symptoms, disseminated, and late stage. Late stage Lyme is when there is a dissemination of the bacteria to the CNS, which can occur within as little as two weeks. Lyme disease may lie dormant for months to years before symptoms of late infection emerge when something (head injury, toxins, EMF) causes the bacteria to cross the blood-brain barrier into the brain.
Patients with late stage Lyme disease present with a variety of neurological and psychiatric problems, ranging from mild to severe, which makes it very hard to connect to infectious disease. Most patients have no recollection of tick bite or falsely believe that a tick has to be engorged to carry bacteria and parasites that can be transmitted. Moreover, they are often told that their prior Lyme disease was “cured” and can't be related to their current symptoms. These problems delay treatment and make it more likely to have late stage Lyme with a neurocognitive or neuropsychiatric impact.
Common Features of Psychiatric Issues Due to Lyme
Since tick-borne bacteria affects the CNS as noted previously, a multitude of symptoms can present. Afflicted individuals can show symptoms immediately or months later and can show a combination of physical, cognitive or psychiatric issues.
Common symptoms of tick-borne disease include: chronic fatigue, sleep problems, brain fog, cognitive and memory impairments, slowed cognitive processing, attention or executive functioning deficits, depression or mood dysregulation, anxiety, OCD, sensory sensitivity, irritability, anger and headaches.
It is important to note that one can have a pre-existing condition prior to Lyme disease that can exacerbate with infectious disease, which further complicates proper diagnosis and treatment. Lyme and tick-borne disease is co-morbid with ADHD, autism, sleep disorders, depression, anxiety disorder, pain and migraines, and can be a source of Pediatric Acute-onset Neuropsychiatric Syndrome (PANS).
What Should You Do?
If you or your child has a history of unexplained medical and mental health symptoms or haven't gotten better with traditional therapies and psychotherapy, consider that infectious disease might be the source of your mental health issue. It is important to note that infectious disease takes many forms and that one may have a single illness, but it is more likely that one is affected by more than one infection, including strep, virus, other bacteria or environmental contaminants such as mold.
The first step is to find a Lyme-literate medical or mental health professional for proper diagnosis and treatment. The best way to do that is to seek a referral from a trusted friend or from Lyme organizations at the regional or national level, such as ILADS, your state Lyme organization or PANDAS.org. As many a patient who has taken this path can attest, you waste your time and may cause further damage to your health by going to an untrained professional.
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