Author: Dr. Chris Winfrey 

The International Lyme and Associated Diseases Society (ILADS) is a nonprofit, international, multidisciplinary medical society dedicated to the diagnosis and treatment of Lyme and other complex inflammatory diseases. With these educational blog posts from experts and members of our board, ILADS aims to promote awareness and understanding of health and wellness, especially as it relates to complex inflammatory diseases, so that we can all learn and grow together. If you have any questions or want more information, you can email us at contact@ilads.org. 

Disclaimer: Every patient is an individual with unique characteristics. This blog article is not medical advice. It does not constitute a physician-patient relationship. It is for educational purposes only. Do not try out what is in this article without medical advice, working with your licensed physician and licensed healthcare providers

In recognition of June as Brain Health Awareness Month, we are pleased to feature a piece on Lyme disease and mental health with Dr. Chris Winfrey, MD, on the ILADS Blog.

The intricate relationship between vector-borne diseases (VBDs) such as the Lyme Disease Complex and mental health can be understood through two main pathways: psychological or physical vulnerability, predisposing one to infection, and the infection itself leading to psychological and cognitive difficulties.

1. Psychological or Physical Vulnerability Leading to Infection

For psychological factors, individuals who have experienced trauma or suffer from PTSD may have compromised mental health, which can impact their immune system. Chronic stress and anxiety can lead to the release of stress hormones like cortisol, which, over time, can suppress immune function. Conditions such as depression and anxiety can affect physical health, reducing overall immunity and making one more susceptible to infections.

For physical vulnerabilities, pre-existing health conditions can weaken the immune system. For instance, individuals with autoimmune diseases or chronic illnesses often have compromised immune defenses, making it easier for infections to take hold. The Hypothalamic-Pituitary-Adrenal (HPA) axis plays a crucial role in stress response. Neuroendocrine Disruption can result in dysregulation of the HPA axis and can impair the body’s ability to fight infections due to the constant release of stress hormones, which can weaken immune response.

2. Infection Leading to Psychological and Cognitive Challenges

Some VBDs, like those in the Lyme Disease Complex, can directly affect the central nervous system. This can lead to neuroinflammation and damage, manifesting as cognitive impairment, memory issues, and difficulty concentrating. The body’s immune response to infection can result in neuroinflammation, which has been linked to psychiatric symptoms such as depression, anxiety, and mood swings.

The chronic nature of VBDs can lead to persistent stress and strain on personal relationships, exacerbating mental health issues. Infections can result in cognitive deficits, impacting daily functioning, academic performance, and occupational capabilities. The combined physical and cognitive symptoms can have an emotional impact, leading to feelings of hopelessness, despair, and disorientation. The loss of functionality and altered mental state can severely impact one’s quality of life and mental well-being.

An Overview of Psychiatric and Cognitive Symptoms

The relationship between Lyme disease and psychiatric symptoms such as depression, anxiety, and cognitive dysfunction is indeed complex and multifaceted. Lyme disease, caused by various species within the Borrelia genus, can have widespread impacts on the body and mind due to its ability to affect multiple systems and processes. Here’s a breakdown of the different pathways through which Lyme disease can contribute to psychiatric and cognitive issues:

Impact on the Gut-Brain Axis and Enteric Nervous System: Certain Borrelia species can affect the gut, influencing the gut-brain axis. This interaction can disrupt the normal functioning of the gut microbiome, which plays a critical role in regulating mood and cognitive functions. The gut is involved in the production of neurotransmitters like serotonin. Disruption in the gut can lead to imbalances in neurotransmitter levels, contributing to mood disorders such as depression and anxiety.

Biofilm Formation and Nutrient Depletion: Borrelia can form biofilms, which are protective matrices that harbor bacteria and sequester essential nutrients such as zinc, magnesium, and iron. These nutrients are vital for the production of neurotransmitters like dopamine, GABA, serotonin, and melatonin. A lack of these nutrients can lead to deficiencies in neurotransmitter production, contributing to symptoms of depression, anxiety, and sleep disturbances.

Mitochondrial Dysfunction and Energy Production: Lyme disease can impair mitochondrial function, leading to reduced energy production. The brain, which requires a significant amount of energy to function properly, is particularly affected by this reduction. The prefrontal cortex, responsible for executive functions such as decision-making and thought processes, can be impaired due to energy deficits. This can lead to difficulties in thinking, frustration in social interactions, and withdrawal from social activities.

Quinolinic Acid and Neurotoxicity: Lyme disease can increase the production of quinolinic acid, a neurotoxin that can cause neurological dysfunction. Elevated levels of quinolinic acid are associated with depressive symptoms and cognitive impairments.

Neurocirculatory Impact and Hypercoagulation: Lyme disease can cause hypercoagulation, leading to thicker blood. This can impair oxygen and nutrient delivery to the brain and impede lymphatic drainage, which is crucial for removing toxins and waste products from the brain. Patients often describe symptoms such as head pressure, headaches, and brain fog, which are indicative of impaired cognitive function due to poor blood flow and oxygenation.

Misconceptions and Complexities in Understanding Lyme Disease and Psychiatric Disorders

The relationship between Lyme disease and psychiatric conditions is often misunderstood, partly due to the way psychiatric disorders are classified in the DSM (Diagnostic and Statistical Manual of Mental Disorders) and partly due to entrenched perceptions in both the medical and mental health communities. The DSM is a descriptive classification tool that does not delve into underlying mechanisms. This can lead to a fragmented view where psychiatric symptoms resulting from Lyme disease are seen as separate from the infection itself. This separation can be misleading because Lyme disease, especially in its tertiary stage, often involves complex neuropsychiatric symptoms that are inherently connected to the infection. It may be more beneficial to diagnose mood disorders as secondary to general medical conditions, like Lyme disease, rather than using terms like major depressive disorder, which often imply a psychodynamic origin. As a consequence, psychiatric symptoms resulting from Lyme disease, such as depression and anxiety, may not be adequately addressed by psychotropic medications and psychotherapy alone. A multi-modal approach, including antibiotics, nutritional support, and interventions targeting the immune and neuroendocrine systems, is often required. This is a distinct difference in this classification than Major Depressive Disorder. 

There may be reasons such as political aims for the shift away from recognizing environmental factors (like infections) as causes of psychiatric problems to a focus on genetic predispositions, social dysfunction, and trauma. Patients and clinicians may struggle to see the connection between Lyme disease and psychiatric conditions, such as PTSD. For example, Lyme disease impacts the hippocampus and amygdala, key regions involved in processing emotions and memories. This can exacerbate traumatic experiences or even create new traumatic memories, complicating the treatment of PTSD and other trauma-related conditions. The cognitive dysfunction caused by Lyme disease can make it difficult for patients to engage in and benefit from traditional psychotherapy, as cognitive processing and emotional regulation are compromised.

Lyme’s Psychological Impact and Behavioral Misinterpretations

Parents often misinterpret changes in their child’s behavior, judgment, and personality as mere immaturity, behavioral issues, or parental failure. The neuropsychiatric effects of Lyme disease, such as impairments in the frontal lobe, can significantly impact these areas. 

One specific example is suicidal states of mind. Often, I share with parents that suicidal thoughts are not natural states of mind in childhood, adolescence, or adulthood. Regression to suicidal states is not a factor of poor parenting (except for cases of extreme abuse and neglect that affects brain functioning) and is not commonplace. Suicide represents the result of a complex array of elements. And they are not brought on simply by disciplining the child, loss and separation, or other social dynamics. I often share that the brain has many safety checkpoints. When someone is suicidal, the brain is regressed and under siege by some entity or anomaly that has bypassed its checks and balance and co-opted the brain(for example, Lyme borrelia serves as a hijacker of the pilot function of the brain). We do not see suicidal states in nature unless something unnatural has occurred. For example, if we see a cow jumping off a cliff, our first thought isn’t that Mr. Cow is upset that Mrs. Cow broke up with him. We might think, instead, of mad cow disease. Often, when loss and separation precedes suicidal states of mind, there is already an existing vulnerability inducing toxic regression, and the loss or break is the last straw. Suicidal thoughts are a product of a toxic environment within the brain, and Lyme disease induces a toxic state of brain. 

When I see severe parental-child conflicts that are long standing and chaotic, I think of two things: 1) congenital and early childhood calamity and 2) frontal lobe dysfunction. The more I see regressive behavior and conflict with the mother, the more I think there was a congenital transmission of infection, toxic insult, hypoxic insult, etc. It has been my clinical experience working with families psychoanalytically and applying these principles of infections that when a child severely blames the mother for their dysfunction, they are not blaming perhaps what the mother has done post-natal, but in-utero.  I also think this when I find extreme maternal guilt for the suffering of their child outside of direct abuse and neglect—when a mother says, “It is all my fault.” This unconscious intuitive recognition of harm done in the womb is hard to articulate. And this model allows for an understanding of how this chaotic matrix could have come to be and what to do about the meaning of the guilt. Most parents and patients find the added environmental hypothesis—that something outside has entered the body that does not belong there—helpful as it reduces blame and guilt. It helps to locate an actual source of the problem, preventing confusion about the problem and orienting a direction towards progress.

Case Studies of Mental Health Improvement With Appropriate Treatment for Lyme Disease

Case Study 1

Jamie is a 28-year-old female that presented to me for anxiety, depression, and insomnia. She voiced significant concern in thinking, processing, regulating her emotions, and relational dependency. Over the course of two years, she never voiced anything positive about her marriage, and expressed a strong desire to end the marriage. From her description, I could appreciate her concerns, as he was belittling, provided limited support, and showed more concern for his work and work relationships over his relationship with her. Despite her desire to leave the marriage, she faced conflict over a lack of financial independence and lack of her own support network (unrelated to his family). She met her husband while he was in the military, and they married and came back to the states.

Her subjective psychic matrix casted her as helpless, small, and vulnerable. I submitted to her that I thought she had Lyme disease, which was a major factor in the thought process, emotional dependency, and anxiety that made her afraid to leave the marriage and take a chance on earning a degree to achieve financial independence. She listed several symptoms of Lyme disease, such as neck stiffness indicative of inflammation of CN 11, symptoms of trigeminal neuralgia, headaches, frustration intolerance, symptoms of dopamine deficiency, insomnia, fatigue, and regressed psychic thoughts. She was placed on appropriate therapy, which included antibiotics, herbal support, inflammation support, gut support, nutrient support, biofilm/fibrin degradation support, depression and anxiety support, and sleep aid. 

Over the next year and a half, she reported feeling stronger, less anxiety, no depression, more mental clarity, and more confidence. Where she had previously felt psychologically small, she exhibited growth in her psychic sense of self, evidenced by standing up to her husband and demanding he either respect her, or they enter into divorce proceedings. She was quite surprised that it led to divorce, and that she had no breakdowns, which would have previously caused her to regress and retract her desire for separation due to a fear of being alone. She had enough cognitive and mental capacity to imagine a future in which would be okay on her own. I, too, was quite surprised by how therapy became much easier for her, as more insights were gained without as much frustration and pain. She is now divorced, living on her own, and is studying for graduate school to enter a professional career. She continues to treat her Lyme disease. Most symptoms have improved, with some still lagging, such as her sleep. Previously, if she had noticed a symptom or change that bothered her, she would have panicked and started to cry in despair because she was confused as to what was happening. Now, she voices more confidence in her body and has knowledge about how to approach changes or symptoms.

Case Study 2

Jessica is a 16-year-old African American female that presented for severe depression, suicidal thoughts, hypersomnia, self-sabtoaging behavior, and anxiety. She was doing well academically, but suffered quite a bit socially. She felt weird, odd, and socially awkward. She had trouble making friends. The friends she did make had mental health struggles themselves. She played sports and other activities where she was one of few Black people among mostly white students.

She described constant comments from peers that she was mean and always appeared angry. She didn’t appear that way to me, so I wondered what they were picking up on. She was told she had “resting bitch face.” Her peers would often think something was wrong and she would share that she was fine. This confusion plagued and bothered her. There were cultural implications, as she was being tagged as the “angry Black girl,” a racial trope of African Americans as aggressive and violent. She felt very frustrated and misunderstood. 

During therapy sessions, I began to notice that she didn’t have much lift in her face. Her affect was rather flat, and her psychomotor functioning was depressive and retarded. There were speech delays and decreased prosody of speech. Her thought process was slow, and often circular and confused, except when she was upset. I submitted to her that I thought she had Lyme, and that her cranial nerves were likely affected. This would cause little lift in her face, leading people to think she was mad or angry when she didn’t feel that way internally. Her lack of energy made her appear zombie-like and her frustration tolerance easily led to social withdrawal. 

What mattered to her as a middle phase adolescent was social connection. We started appropriate antibiotics, lymphatic drainage support, gut support, immune support, and basic minerals. Over 6 months, she started to have more energy, more lift in her face, less confusion, and more liveliness and vitality in her disposition. This led to her dating, having less racial and social tension, and receiving praise from her teachers on the work she was doing. She has not completed treatment and still exhibits confusion in working on social dynamics, but the feelings of being misunderstood have significantly improved, and she is not being seen as the “angry Black girl.” She continues to struggle with her current friends because she made them while in a  “toxic mental space” and fears leaving them behind as she gets better. As a result, the pace of treatment had to be altered to parallel the pace of her psychic development so as to not induce another trauma. It would be imperative for her to work out this conflict between her overall improvement and the impact it has on existing relationships, change in dynamics of those relationships, and the possible development of new relationships. This would represent psychic loss and grief of growth, or a term called post traumatic growth. 

Important Concerns For Healthcare Providers

It is important for mental health providers to be aware of the impact of Lyme on psychic functioning, the limits it poses on recovery, and its impact on traditional mental health treatment. It is important for non-mental providers to be aware of the impact of Lyme disease on mental functioning. And it’s crucial for both types of providers to understand the need for collaborative care. 

It is vital to understand the direct impact of the bug on the brain, mental functioning, and subsequent treatment. This is the metaphor I often use to describe the process to patients: It’s like going to war, and trying to get the bad guys without killing the good guys. The treatment itself can cause mental strain when toxins release from killing bacteria, inflammation surges, and all the elements of treatment produce a lot of wear and tear—it is a long treatment. It is important to also keep in mind that some patients need breaks or pauses because the treatment may be moving the brain and mind forward too quickly. Or, the infection causes mental arrest and the treatment awakens dormant issues that were not properly addressed before, such as a trauma. This can be very scary for patients, as they can think the treatment is making them worse while it’s actually awakening pre-existing issues they need to address before moving forward. 

It is important to know that these infections, toxins, and mental conflicts operate at certain frequencies, and oftentimes link together if the energy matches. Therefore, it is important to address them slowly at the same time. Not addressing one of these key areas can induce resistance to progress, at no fault to the patient or clinician. 

The Relationship Between Lyme Disease and Psychiatric Conditions

In summary, understanding the multifaceted relationship between Lyme disease and psychiatric conditions requires a shift in both medical and psychiatric perspectives. Understanding the bidirectional relationship between VBDs and mental health underscores the need for integrated care. Lyme disease can contribute to both psychiatric and cognitive dysfunction through multiple pathways, including disruption of the gut-brain axis, nutrient sequestration by biofilms, mitochondrial dysfunction, neurotoxin production, and impaired blood flow. Compromised bodily functioning can predispose one to contract Lyme disease, making it even more difficult to treat.

Understanding these mechanisms is vital for developing effective treatment strategies that address both the physical and mental health aspects of Lyme disease. Recognizing the direct impact of the infection on brain function and mood can lead to more effective, integrated treatment approaches. This holistic view not only improves patient outcomes but also provides a more compassionate framework for understanding the struggles faced by those with Lyme disease and their families.

You can contact Dr. Chris Winfrey, MD  at New Image Wellness, https://newimagewellness.net/.