The invisible symptoms of Lyme disease – Part 1
Mental illnesses associated with Lyme disease
The occurrence and significance of mental symptoms
The neuropsychiatric consequences of Lyme disease have long been known: numerous articles in the literature confirm that the disease can also be accompanied by psychiatric symptoms such as paranoia, dementia, schizophrenia, bipolar disorder, panic attacks, major depression, anorexia nervosa and obsessive-compulsive disorder. One study showed that after a diagnosis of Lyme disease, the rate of psychiatric disorders increased by 28% and the number of suicide attempts doubled after infection. Another study found that patients with chronic Lyme disease often experience neuropsychiatric symptoms and cognitive decline. This phenomenon is also important because mental symptoms are often treated as independent psychiatric disorders, and the role of the infection itself is not taken into account — thus delaying diagnosis and targeted treatment.
Mechanisms: how can mental symptoms develop during Lyme infection?
The development of mental symptoms cannot be explained by a single simple mechanism; there are several overlapping pathways that can lead to psychiatric or cognitive disorders. One central mechanism is neurological infection: the bacterium — or the immune response it triggers — can enter the central nervous system and cause meningoencephalitis-like symptoms (e.g. radiculoneuritis, chronic encephalopathy). In addition, so-called psychoimmunological mechanisms also play a role: chronic inflammation developing during the infection, cytokine activation (e.g. IL-6, IL-8, IL-12, IL-18, interferon-γ) and the production of antineural antibodies can all contribute to brain dysfunction. The combination of immune responses and nervous system processes may explain why “brain fog”, attention and memory disorders, and mood swings (e.g. depression, anxiety) can develop in people with Lyme disease. Overall, therefore, it is not just the presence of the bacterium that matters in Lyme disease, but the subsequent immune damage, structural changes in the nervous system, chronic inflammation and their mental consequences.
Symptoms and clinical picture
Mental and cognitive symptoms are diverse and can vary in severity, ranging from mild attention or memory problems to severe psychosis.
Depression and mood disorders
Depression is relatively common in chronic Lyme disease: according to one study, 26–66% of patients experienced depression. A larger population study confirmed that the rate of mental illness increases after a diagnosis of Lyme disease — especially depression and suicidal tendencies. Mood disorders are often accompanied by anxiety, sleep disturbances and exhaustion. If Lyme disease is the underlying cause, an important distinguishing feature is that these symptoms do not respond well to traditional depression treatment.
Anxiety, panic, sleep disturbances
Anxiety symptoms also frequently appear: panic attacks, feelings of fear, sleep disorders. Sleep problems may be partly due to pain and partly to brain inflammation or nervous system involvement. Such infectious conditions may often lie behind the complaints of patients who are anxious about everything and unable to calm down.
Cognitive impairment, “brain fog”
Patients often complain of difficulty concentrating, slow thinking, forgetfulness, and indecisiveness — many feel that their minds are “foggy”. According to the literature, cognitive impairments associated with Lyme disease may include decreased verbal fluency, attention deficits, memory problems, and slower thinking. In people with long-term infection, we often find symptoms such as suicidal thoughts and extreme outbursts of anger, which were previously rarely attributed to Lyme infection.
More severe psychiatric symptoms include psychosis, personality and behavioural changes.
Although less common, there have been documented cases of Lyme disease presenting with psychotic symptoms such as hallucinations, delusions, paranoia, bipolar-like symptoms and even aggressive behaviour. Late neurological involvement, such as encephalopathy or meningitis, can also cause personality changes and behavioural problems.
Behavioural disorders and attention deficit disorder in childhood
In children, the infection can also cause psychiatric/behavioural symptoms such as anxiety, attention deficit hyperactivity disorder (ADHD-like symptoms) and even tic-like movements.
The range of symptoms can therefore vary from mild mood disorders to severe psychiatric conditions. It is important that the examining physician considers the possibility of Lyme disease in connection with these symptoms, especially if other physical symptoms are also present (e.g. joint pain, fatigue, neuropathy).
Diagnostic, clinical and treatment challenges
Recognising and treating the mental symptoms of Lyme disease presents a number of difficulties. Firstly, in many cases, the classic symptoms of Lyme disease (e.g. erythema migrans, characteristic fever and muscle pain) are absent or not recognised in time. This delays diagnosis and allows the disease to progress, affecting the nervous system. Secondly, due to the nature of the psychiatric symptoms, they are often assumed to be an independent mental illness, and the infectious background is not taken into account. Thirdly, laboratory diagnostics do not always provide complete certainty: serological tests are not perfectly sensitive, and the clinical picture can be complex, especially when the nervous system is already affected. It is therefore important to use direct testing methods, where available, as their sensitivity is significantly higher than that of serological tests. It follows from the above that the infection does not always affect the central nervous system directly, but sometimes only indirectly, through cytokines and chemokines, or through damage to the peripheral nervous system, which is why intrathecal Borrelia antibody production cannot always be detected, and thus a laboratory diagnosis of neuroborreliosis cannot always be made, even though the neurological symptoms are pronounced.
It is also important to note that the quality of life of affected patients is greatly affected by constant fatigue, brain fog, mood swings and attention deficits. These can lead to a decline in work capacity, social relationships and psychological well-being.
Summary
In short, Lyme disease is not just an infection with skin and joint symptoms: the bacteria and the subsequent immune processes can also affect the nervous system, which can have mental and psychiatric consequences. Unfortunately, these symptoms often remain hidden or are misinterpreted. Since mental health issues – whether depression, anxiety, cognitive impairment or psychosis – have a significant impact on quality of life, it is essential to assess and treat them. Cooperation between the medical and psychological professions, patient-centred care and preventive measures can all contribute to reducing the mental burden caused by Lyme disease and enabling patients to live as full and better lives as possible.
Sources:
https://pubmed.ncbi.nlm.nih.gov/7943444/
https://www.columbiapsychiatry.org/news/lyme-disease-heightens-risk-mental-disorders-suicidality
(C) Lyme Borreliosis Foundation
