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‘Tis the Season for Lyme Literacy

These basic facts could change the way mental health clinicians practice.

Key points

  • Untreated and under-treated Lyme disease are an underrated public health burden costing billions.
  • Lyme can lead to wide-ranging psychiatric symptoms, from cognitive impairments to severe mood disorders.
  • Mental health clinicians are uniquely placed to see the impact and provide advocacy.
Erik Karits/Pexels
Source: Erik Karits/Pexels

The balmy, and at times this year scorching, embrace of summer ushers us outdoors but also introduces us to a silent adversary: ticks. These minuscule entities are more than mere irritants; they carry the potential to transmit a myriad of infections, each bearing its own set of challenges.

One may not think knowledge of these diseases is needed for psychotherapy, but we are sometimes best positioned to notice the more subtle psychiatric presentations, and the danger of undertreatment can amplify the risks and lead to debilitating long-term consequences.

Lyme's Health and Mental Impact

The psychiatric manifestations of Lyme disease, one of the most common tick-borne illnesses, can be both profound and diverse. Clients may experience cognitive impairments, mood disturbances, and even severe psychiatric disorders. Lyme can even trigger episodes resembling panic disorder, severe depression, bipolar disorder, and anxiety disorders. Sleep disturbances and fatigue further exacerbate the individual's distress, including a higher correlation to death by suicide.

Moreover, these symptoms often blur the lines between neurological and psychiatric domains. For instance, a patient may present with memory lapses, difficulty concentrating, or even obsessive-compulsive tendencies. When these things happen and are sudden onset, particularly late in life, and coupled with chronic physical maladies in an endemic area, clinical red flags should be raised. Such neuropsychiatric manifestations can be misleading, as these patients, in my own clinical experience, are very often referred by their physicians.

Diagnostic and Treatment Challenges

Undertreating tick-borne illness, including Lyme disease, risks more than just prolonged symptoms. It can potentially amplify the disease's impact on the body and mind, allowing for the infection to take deeper roots. Over time, untreated or undertreated infections can result in complications that are even more challenging to address, including dementia, myocarditis, neuropathy, and more.

To frame this within a larger context, the CDC highlights nearly 500,000 new Lyme diagnoses each year, with up to 20 percent of these evolving into chronic conditions. Despite the fact that studies have estimated those with chronic Lyme cost many billions of dollars to the economy, the presentation, course, and treatment are not well known, not well taught, and not well understood. This is a significant public health gap and burden.

Part of the reason for this cost is that the journey to diagnosing and treating Lyme and its tick-borne kin remains riddled with complexities. The average patient spends years and multiple specialists to reach a treatable diagnosis. Discord arises from varying testing methodologies and occasional data misinterpretations. In Virginia, physicians used to be required by law to disclose the low quality of one of the most common testing tools. Both patients and medical professionals tread a path with no uniform guidance, confronted with a plethora of treatment avenues and a dearth of consensus. This lack of alignment often results in communication chasms, leaving many in medical limbo.

Enhancing Care and Awareness

I know these things to be fact from years of research, client work, and my own personal trials. Years of unexplained symptoms, numerous consultations, and a labyrinth of potential diagnoses illuminated for me the challenges faced by many. Understanding the intricacies of Lyme disease and associated tick-borne illnesses is paramount for mental health professionals. Misinterpreting Lyme-related neuropsychiatric symptoms as standalone psychiatric disorders can lead to unnecessary and sometimes counterproductive interventions. Instead of gaining relief, patients may find themselves on a hamster wheel of treatments that do not address the root cause.

Such missteps not only hinder the individual's recovery but also inflate healthcare costs due to misallocated resources. In a broader societal framework, the consequences of underdiagnosing or mistreating Lyme ripple out, causing strained healthcare systems, missed workdays, and diminished community well-being. Addressing tick-borne diseases with a keen, informed eye is not just a medical necessity; it's a societal imperative.

Amid the cacophony of debates on Lyme, a resounding truth emerges: Embracing the multifaceted nature of tick-borne diseases and understanding the ramifications of undertreatment is paramount. Healthcare is a journey, often devoid of binary solutions. By fostering an environment of collaboration, open-mindedness, and relentless pursuit of knowledge, we edge closer to enhanced care and understanding for all.


Fallon, B. A., Madsen, T., Erlangsen, A., & Benros, M. E. (2021). Lyme Borreliosis and Associations With Mental Disorders and Suicidal Behavior: A Nationwide Danish Cohort Study. The American Journal of Psychiatry. Advance online publication.

Columbia Lyme and Tick-Borne Diseases Research Center. (n.d.). Lyme disease signs and symptoms. Retrieved from

Centers for Disease Control and Prevention. (n.d.). Lyme FAQ. Retrieved from (n.d.). Lyme Disease Costs May Exceed $75 Billion per Year. Retrieved from (n.d.). Lyme Disease Research Studies. Retrieved from

Horowitz, R. I. (2013). Why Can't I Get Better? New York: St. Martin's Press.

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