Lyme disease causes depression

[ARTICLE]

http://www.ilads.org/PsychiatristBrochure.pdf

http://theeffexoractivist.org/forum/viewforum.php?f=27

What to Do?
Screen patients for Lyme symptoms, especially those with
complicated or atypical presentations. Be suspicious of
Lyme if a patient mentions cognitive changes, extreme
fatigue, weight changes, headaches, fibromyalgia, a
history of “mono,” “spider bites,” multiple sclerosis,
explosive rages or sudden mood swings. To elicit data
about cognitive problems ask broad questions such as,
“How do you think your brain is functioning?” or “How
many things can you handle at one time?”
Consider Lyme disease in children with behavioral
changes, fatigue, school phobias, academic problems,
learning disabilities, headaches, sore throats, GI
complaints and/or migrating pains. In teens, Lyme
disease may be complicated by drug abuse.
The Lyme spirochete is slow growing and can be difficult
to treat, so be sure the patient is treated with appropriate
antibiotics for at least two to four weeks beyond symptom
resolution.
Most individuals with Lyme disease respond to
antibiotics, but the treatment course is highly patientspecific.
ILADS has published evidence-based
guidelines for the diagnosis and treatment of Lyme and
associated tick-borne diseases (Expert Rev Anti-Infect
Ther 2004;2(Suppl):S1-S13). For more information,
visit the ILADS website at www.ilads.org.
Some of the common symptoms of late-stage (tertiary)
Lyme disease and other tick-borne co-infections:
• Profound fatigue
• Chills, sweats and skin flushes
• Night sweats
• Migrating arthralgias
• Muscle pains/twitching
• Sleep disturbances
• Severe headaches
• Shifting neurologic pains
• Tremors, shakiness
• Numbness, tingling sensations, pain often
shifting and unusual in type
• Cranial nerve disturbance
(Facial numbness, pain, tingling, paralysis, optic
neuritis, trouble swallowing, distortion of
smell or taste) See Category below.
The more severe neurological symptoms or disorders
associated with late-stage Lyme disease:
• Progressive dementias
• Seizure disorders
• Strokes
• ALS-like syndrome (similar to Lou Gehrig’s Disease)
• Guillain-Barre-like syndrome
• Multiple sclerosis-like syndrome
• Parkinson’s disease-like syndrome
• Other extrapyramidal disorders
• Visual disturbances or loss
Checklist of common cognitive impairments in
Lyme disease (from Marian Rissenberg, Ph.D.,
clinical neuropsychologist)
Losses in fields of attention/executive functions such
as inability to maintain divided or sustained attention,
auditory and mental tracking and scanning, and
memory retrieval can affect:
• Memory functions (lost items, missed
appointments, retold stories)
• Language functions (halting speech, disrupted
participation in conversation)
• Visual/Spatial Processing (Inability to find things,
tendency to get lost, disorganization, difficulty
reading, especially for enjoyment)
• Abstract reasoning (Poor problem-solving/
decision-making)
• Slowed processing speed (Familiar tasks take l
onger, can’t follow conversations well).
Most or all of these impairments, if caused by
neuroborreliosis, may improve with proper
antibiotics combined with other appropriate
symptomatic treatments.
Disclaimer
The foregoing information is for educational purposes
only. It is not intended to replace or supersede patient
care by a healthcare provider. If an individual suspects
the presence of a tick-borne illness, that individual
should consult a healthcare provider who is familiar with
the diagnosis and treatment of tick-borne diseases.
Edited by
Drs. Virginia T. Sherr and Debra J. Solomon,
Psychiatrists

When Should a Psychiatrist Suspect
Lyme Disease?
In a published study (Hajek et al, Am J Psychiatry
2002;159:297-301), one-third of psychiatric inpatients
showed signs of past infection with the Lyme
spirochete, Borrelia burgdorferi. The International
Lyme and Associated Diseases Society (ILADS) has
found that even severe neuropsychiatric behavioral
symptoms in this population can often be reversed or
ameliorated when antibiotics are used along with the
indicated psychiatric treatments.
Don’t miss this crucial diagnosis.
Patients with late-stage Lyme disease may present with
a variety of neurological and psychiatric problems,
ranging from mild to severe. These include:
• Cognitive losses including:
o Memory impairment or loss (“brain fog”)
o Dyslexia and word-finding problems
o Visual/spatial processing impairment (trouble
finding things, getting lost)
o Slowed processing of information
• Psychosis
• Seizures
• Violent behavior, irritability
• Rage attacks/impulse dyscontrol
• Anxiety
• Depression
• Panic attacks
• Rapid mood swings that may mimic bipolarity
(mania/depression)
• Obsessive compulsive disorder (OCD)
• Sleep Disorders
• Attention deficit/hyperactivity disorder
(ADD/ADHD)-like syndrome
• Autism-like syndrome
Lyme disease is one of the fastest growing infectious
diseases in the nation. The Centers for Disease Control
and Prevention (CDC) reported over 23,783 new cases
in 2002, and the government agency estimates that
the total number may be tenfold higher. The disease
is caused by the bite of a deer tick infected with the
Borrelia burgdorferi (Bb) spirochete and may be
complicated by other parasites or co-infections. It is
hard to diagnose because fewer than half of all Lyme
patients recall a tick bite or develop the signature
erythema migrans (“bullseye”) rash. As a result, many
patients go untreated and develop psychiatric and/or
neurological symptoms.
Lyme disease sometimes begins as a flu-like illness
accompanied by fever, headache, sore throat and joint
pain. After infection, patients may develop cardiac
or early neurologic problems including meningitis,
encephalitis and cranial neuropathies. Look for
eyelid droop, facial weakness, numbness or pain,
shoulder droop, sensory distortions or any other focal
neurological signs. There may be a history of neck
pain and stiffness or muscle twitching.
Some patients may have arthritic symptoms in single
or multiple joints. Most patients mention this to a
psychiatrist only if directly asked.
At any time after a tick bite, patients may also exhibit
cognitive symptoms such as memory and concentration
impairments and word-finding difficulties, ADD/
ADHD-like symptoms, learning disabilities, OCD,
crying spells, rages, depression/bipolar disorder, panic/
anxiety disorders and psychoses - all may be caused or
exacerbated by Lyme disease.
Disorders of the nervous system have been found in 15
– 40% of late-stage (tertiary) Lyme patients (Caliendo
et al, Psychosomatics 1995;36:69-74). When Lyme
disease affects the brain, it is often referred to as Lyme
neuroborreliosis or Lyme encephalopathy. Usually the
patient is totally unaware of its presence.
Neuroborreliosis 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 and organic psychiatric illness. Such
symptoms may be dormant, only surfacing years later.
Dr. Brian Fallon, director of the Lyme Disease
Research Program at Columbia University and
principal investigator of the NIH-funded study of
brain imaging and persistent Lyme disease, cites five
questions that imply warning signs of possible Lyme
encephalopathy:
• Are there markers of non-psychiatric disease such
as erythema migrans rash, arthralgias or arthritis,
myalgias, severe headaches, sound or light
sensitivity, paresthesias, diffuse fasciculations,
cardiac conduction defects, word-finding problems,
short-term memory loss, tremors, cranial neuropathies,
and/or radicular or shooting pain?
• Is this psychiatric disorder atypical or unusual?
For example, does a panic attack last longer than
the expected 1/2 hour? Or is it a first ever panic
attack at age 50?
• Is there poor or paradoxical response or excessive
side effect sensitivity to medications that are
expected to be helpful for particular psychiatric
symptoms?
• Is this new-onset disease without psychological precipitants
such as new stressors or secondary gain?
• Is there an absence of a personal history or family
history of major psychiatric disturbances?
Negative answers to these questions do not rule out the
presence of Lyme disease. But a “yes” to most of the
questions, especially in a patient with an out-of-doors
lifestyle or a pet, demands further clinical assessment.
Dr. Fallon recommends Western blot serologic studies,
lumbar puncture, neuropsychological testing, brain
MRI and SPECT (single photon emission computerized
tomography) scans. For more information, see www.
columbia-lyme.org.
Other helpful tests may include PCR for Borrelia
burgdorferi in blood, serum, cerebrospinal fluid
(CSF) and urine, and/or Borrelia antigen testing in
urine and CSF.
Because blood tests at the top three general medical
laboratories in the nation fail to detect 35% of Lyme
antibodies, ILADS recommends use of laboratories
that specialize in Lyme and other tick-borne illnesses.
Contact www.lymediseaseassociation.org for a listing
of recommended labs.
Blood tests should not be used to rule out Lyme disease
when there is a strong clinical presentation. Dr. Robert
Bransfield, a psychiatrist who specializes in infectious
causes of neuropsychiatric illness, has developed a
structured clinical interview to assess seronegative
patients. See www.mentalhealthandillness.com