LDA/Columbia 2011
Scientific Conference

Hyatt Penns Landing

Philadelphia, PA

October 1-2, 2011

Category:  Lyme overlap with other Diseases

My child had Lyme Disease, got treated, and is now depressed. Could this be a sign of a relapse?

Depression is a word that encompasses physical, cognitive, and emotional components. The physical would be poor sleep, fatigue, low energy, lack of sex drive. The cognitive would include poor concentration and trouble making decisions. The emotional would include feeling guilty, hopeless, suicidal, and being unable to enjoy life in any aspect. Chronic Lyme Disease is most often associated with insomnia, fatigue, headaches, pain, and, not uncommonly, problems with cognition as well. In other words, chronic Lyme disease is most often associated with the physical and cognitive parts of the depressive picture and less often with the emotionally despairing part. When a person presents with the emotional part, it is most often due to a primary depression unrelated to Lyme Disease. One should wonder about an underlying medical illness when there are: a)Atypical features to the depression; b)an atypical response to good psychiatric treatments; or c) when the physical symptoms are more predominant. Although it should be noted that the elderly often present with primarily physical complaints - not emotional ones - as their manifestation of primary depression. When a person has Lyme encephalitis, the emotional part of depression can be very dramatic. The person might be suddenly tearful for no apparent reason, have very poor frustration tolerance, become angered at the least provocation, and appear to have a personality change. The emotional aspects of depression might occur secondarily to being sick with a physical illness or directly from an infection affecting the brain or from chemicals affecting the brain that were released by infection outside of the brain. Regarding your question about your child, I can not give specific advice regarding a specific person I have not seen. However, in general, if the child does not have other features of Lyme disease present, such as marked fatigue, headaches, joint pain, muscle pain, then I would think it less likely that the depression is a sign of a relapse. Remember that Lyme Disease is most often a multi-systemic illness with multi-systemic problems. It may be helpful to refer to a child psychiatrist. If the child is not improved within several months, then consider a more thorough work-up. The work-up might include repeat blood tests, neuropsychological tests, MRI, SPECT. A spinal tap can be helpful -- although not always abnormal in the present of neurologic Lyme Disease, when it is abnormal that is a helpful sign of brain involvement currently.

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