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Lyme Disease

Lyme Borreliosis and Associations With Mental Disorders and Suicidal Behavior: A Nationwide Danish Cohort Study

Lyme Borreliosis and Associations With Mental Disorders and Suicidal Behavior: A Nationwide Danish Cohort Study. Brian A. Fallon, M.D., M.P.H., Trine Madsen, Ph.D., Annette Erlangsen, Ph.D., Michael E. Benros, M.D., Ph.D. Published Online:28 Jul 2021 https://doi.org/10.1176/appi.ajp.2021.20091347

“Having more than one episode of Lyme borreliosis was associated with increased incidence rate ratios for mental disorders, affective disorders, and suicide attempts, but not for death by suicide. Individuals diagnosed with Lyme borreliosis in the hospital setting had an increased risk of mental disorders, affective disorders, suicide attempts, and suicide. Although the absolute population risk is low, clinicians should be aware of potential psychiatric sequelae of this global disease.”

Lyme Borreliosis and Associations With Mental Disorders and Suicidal Behavior: A Nationwide Danish Cohort Study
Fallon BA, Madsen T, Erlangsen A, Benros ME. Lyme Borreliosis and Associations With Mental Disorders and Suicidal Behavior: A Nationwide Danish Cohort Study. Am J Psychiatry. 2021 Oct 1;178(10):921-931. doi: 10.1176/appi.ajp.2021.20091347. Epub 2021 Jul 28. PMID: 34315282.
  • Results showed that individuals with Lyme borreliosis had higher rates of mental disorders, affective disorders, suicide attempts, and death by suicide compared to those without Lyme borreliosis.
  • The 6-month interval after diagnosis had the highest rate of any mental disorder, and the first 3 years after diagnosis had the highest rate of suicide.
  • Multiple episodes of Lyme borreliosis were associated with increased incidence rate ratios for mental disorders, affective disorders, and suicide attempts.
  • Clinicians should be mindful of the potential psychiatric consequences of Lyme borreliosis, despite the low absolute population risk.
PANDAS and Persistent Lyme Disease With Neuropsychiatric Symptoms: Treatment, Resolution, and Recovery

Cross Amy, Bouboulis Denis, Shimasaki Craig, Jones Charles Ray. Case Report: PANDAS and Persistent Lyme Disease With Neuropsychiatric Symptoms: Treatment, Resolution, and Recovery. Frontiers in Psychiatry. Vol 12, 2021. DOI:10.3389/fpsyt.2021.505941  

The subject of this case report had a concomitant diagnosis of Lyme borreliosis and PANDAS, both of which are consistent with the neuropsychiatric symptoms she experienced. As evidenced by her recovery and resolution of symptoms, treating both the Lyme infection and streptococcal infection, as well as treating the underlying autoimmune etiology of her neuropsychiatric symptoms resulted in a successful outcome. This case report and treatment history reiterates the complex and challenging nature of infection-triggered autoimmune neuropsychiatric disorders such as PANDAS and PANS and that multiple concomitant infectious agents can frequently be identified in patients suffering from these complex neuropsychiatric disorders. The presence of elevated antineuronal antibodies identified by the Cunningham Panel™ provided an aid in the diagnosis and in directing immunomodulatory treatment. The post-treatment resolution of these autoantibodies provided pathophysiological support for addressing both the infection(s) and the underlying immune system dysfunction which resulted in a positive medical outcome for this patient.

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Depressive Symptoms and Suicidal Ideation Among Symptomatic Patients With a History of Lyme Disease vs Two Comparison Groups
Doshi S, Keilp JG, Strobino B, McElhiney M, Rabkin J, Fallon BA. Depressive Symptoms and Suicidal Ideation Among Symptomatic Patients With a History of Lyme Disease vs Two Comparison Groups. Psychosomatics. 2018 Sep-Oct;59(5):481-489. doi: 10.1016/j.psym.2018.02.004. Epub 2018 Mar 1. PMID: 29606281; PMCID: PMC6119532.

The study reveals that depression is reported in 8-45% of post-treatment Lyme disease syndrome (PTLDS) patients, with limited knowledge of suicidal tendencies. A comparison of depression and suicidality between PTLDS, HIV/AIDS patients, and a non-patient group shows a significant increase in suicidal tendencies among depressed individuals. Depression levels in PTLDS and HIV/AIDS patients are statistically similar. The study emphasizes that one in five PTLDS patients reported suicidal thoughts, underscoring the need for screening depression and suicidality to enhance patient care.