Linking depression & Lyme

During Lyme Disease Awareness Month (May), we look back in our files at a compelling article from our Issue 16 of our newsletter (which was printed over 15 years ago) about Lyme disease & depression. We have a long-standing commitment to raising awareness about the complexities of Lyme disease. 

Edited excerpt from Breakspear Medical Bulletin Issue 16:

Linking depression and Lyme disease

A patient wrote in to our medical team, “I’ve never suffered from depression in the past but for the past 6 months, I have been feeling generally ill, flu-like and depressed and I don’t know if this is related, but I also have a rash.  My GP has given me antidepressants but I am still feeling very low. Is there anything else that can be done?”

Causes of depression

There are many causes of depression. ‘Endogenous’ depression can occur due to stressful life events, such as a major move, or bereavement, or divorce. This sort of depression would hopefully improve depending on a person’s social support and situation.

Depression may also affect a person seemingly out of the blue. There may be several other causes for this to happen, but when it is combined with feeling ill and having other physical symptoms like a rash or fever, then the depressive symptoms should not be thought to be purely endogenous. The depression may be treated with antidepressants, but the underlying cause should also be sought.

The known medical causes of depression include thyroid disorders, multiple sclerosis, obstructive sleep apnoea, systemic lupus erythematosus and infections such as syphilis, HIV and Lyme disease. For example Lyme disease has been described as the cause of panic-like episodes.¹

Lyme disease & unusual symptoms

In the Journal of Psychiatric Practice article linking panic attacks and previously unsuspected chronic disseminated Lyme disease, cases were also found to complain of sensitivity to light, sound and touch, joint pains, cognitive difficulties and neurological pain. They were found to have positive tests for borreliosis, babesiosis and erhlichiosis. Treatment of their infections resulted in reduction of symptoms.

Lyme disease can be a neuropsychiatric illness.² A broad range of psychiatric reactions have been associated with Lyme disease, including paranoia, dementia, schizophrenia, bipolar disorder, panic attacks, major depression, anorexia nervosa and obsessive compulsive disorder.

A further recent report describes Bartonella as the underlying cause of new onset depression, panic attacks and personality changes.³ Bartonella should be suspected when depression or other psychiatric symptoms are reported together with the presence of a rash, fevers, enlarged lymph nodes, fatigue, vision abnormalities and neurological pain.

Bartonella may be transmitted by fleas, flea faeces, cat scratches or licks, ticks, lice and biting flies. Nine Bartonella bacteria have been identified that are known to infect humans. At the time of publication (2007), the largest national laboratories in the US offer tests for only 2 species (B quintana and B henselae). It is therefore necessary to carefully consider the risk factors and associated symptoms in order to make the provisional diagnosis and thus allow consideration of antibiotic therapy. As Bartonella is an emerging infection, there is no clear standard of care with antibiotic therapy. Antibiotics that have been used with reported success include combinations of azithromycin, rifampicin, co-trimoxazole, quinolones (levofloxacin, ciprofloxacin) and doxycycline. Penicillin and cephalosporins are not active against the organism. Treatment regimes last 3 to 6 weeks on average, with severe infections requiring more than 3 months of treatment.

If you are suffering not only from depression, but also from other physical complaints, my advice would be to talk to your doctor about possible infectious causes of depression, particularly if you can identify some of these risk factors. My view is that these infections should be tested for, and, if identified, should be treated with the correct antibiotics.

At Breakspear Medical, we test for Lyme, Bartonella and other tick-borne infections, using specialist laboratories in the US and Europe and if your history, symptoms and test results strongly indicate it, you should discuss a trial of antibiotics under close supervision from your doctor.

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The response to the patient’s query was written by Dr Christabelle Yeoh. She worked at Breakspear Medical 2006-12 before moving to Australia to marry.  She is currently the Medical Director of GenBiome Medical Clinic in Sydney and was a director and past president at the Australasian College of Nutritional and Environmental Medicine (ACNEM) and is active on the teaching faculty.

References:

1. Sherr VT. Panic attacks may reveal previously unsuspected chronic disseminated Lyme disease. J Psychiatr Pract. 2000;6:352-6.
2. Fallon BA, Nields JA. Lyme disease: a neuropsychiatric illness. Amer J Psychiatry. 1994;151:1571-83.
3. Schaller JL, Burkland GA, Langhoff PJ. Do Bartonella infections cause agitation, panic disorder, and treatment-resistant depression? MedGenMed. 2007;9:54.