Lyme, Depression, and Suicide

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Lyme, Depression, and Suicide

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By Robert C. Bransfield, MD

 

 

 

In the late 1970’s, I treated a depressed patient who appeared to have

more than just depression. Her weight increased from 120 to 360 pounds, she

was suicidal, had papille & shy;dema, arthritis, cognitive impairments, and

anxiety. This patient became disabled, went bankrupt, and had marital problems.

Like many whose symptoms could not be explained, she was re & shy;ferred to

a psychiatrist. However, I was never comfortable labeling her condition as

just an & shy;other depression. At the time, I did not consider her illness

could be connected to other diagnostic entities, such as neuroborreliosis,

erythema migrans disease, erythema chronicum migrans, Bannwoth’s syndrome,

Garin-Bujadoux syndrome, Montauk knee, or an ar & shy;thritis outbreak in

Connecticut With time, the connec & shy;tion between Borrelia burgdorferi

infections and men & shy;tal illnesses such as depression became increasingly

apparent.

 

In my database, depression is the most common psychiatric syndrome

associated with late stage Lyme dis & shy;ease. Although depression is common in

any

chronic illness, it is more preva & shy;lent with Lyme patients than in most

other chronic illnesses. There appears to be multiple causes, including a

num & shy;ber of psychological and physical fac & shy;tors.

 

From a psychological standpoint, many Lyme patients are psychologically

overwhelmed by the large multitude of symptoms associated with this disease.

Most medical conditions primarily affect only one part of the body, or only

one organ system. As a result, patients singularly afflicted can do

activities which allow them to take a vacation from their dis & shy;ease. In

contrast, multi-system diseases such as Lyme, depression, chronic Lyme disease

can penetrate into multiple as & shy;pects of a person’s life. It is difficult

to escape for periodic recovery. In many cases, this results in a

vi & shy;cious cycle of disappointment, grief; chronic stress, and

demoralization.

 

It should be noted that depression is not only caused by psychological

factors. Physical dysfunction can directly cause depression. Endo & shy;crine

disorders such as hypothyroidism, which cause depression, are sometimes

associated with Lyme disease and further strengthen the link be & shy;tween Lyme

disease and depression.

 

The most complex link is the association between Lyme disease and central

nervous system functioning. Lyme encephalopathy results in the dysfunction

of a number of different mental func & shy;tions. This in turn results in

cognitive, emotional, vegetative, and/or neurological pathology. Although all

Lyme disease patients demonstrate many similar symptoms, no two patients

present with the exact same symptom profile.

 

Other mental syndromes associated with late state Lyme disease, such as

attention deficit disorder, panic disorder, obsessive-compulsive disorder,

etc., may also contribute to the develop & shy;ment of depression. Dysfunction

of other specific pathways may more directly cause depression. The link

between encephalopathy and depression has been more thoroughly studied in

other illnesses, such as stroke. The neura1 injury from a stroke causes neural

dysfunction that causes depression. Injury to specific brain regions has

different statisti & shy;cal correlation with the development of depression.

Once depression or other psychiatric syndromes occur with Lyme disease,

treating them effectively improves other Lyme disease symptoms as well and

prevents the development of more severe conse & shy;quences, such as suicide.

 

Suicidal tendencies are common in neurop & shy;sychiatric Lyme patients.

There have been a number of completed suicides in Lyme disease patients and

one published account of a combined homicide/suicide. Suicide accounts for a

significant number of the fatalities associated with Lyme disease. In my

database, suicidal tendencies occur in approxi & shy;mately 1/3 of Lyme

encephalopathy patients. Homicidal tendencies are less common, and

oc & shy;curred

in about 15% of these patients. Most of the Lyme patients displaying

homicidal tendencies also showed suicidal tendencies. In contrast, the incident

of

suicidal tendencies is comparatively lower in individuals suffering from

other chronic illnesses, such as cancer, cardiac disease, and diabetes.

 

To better understand the link between Lyme disease and suicide, let’s

first look at an overview of suicide. Chronic suicide risk is particularly

associ & shy;ated with an inability to appreciate the pleasure of life

(anhedonia). People tolerate pain without becoming suicidal, but an inability

to

appreciate the pleasure of life highly correlates with chronic suicidal risk.

Of course, there are many other factors that also contribute to chronic

risk. For example, one study demonstrated that 50% of patients with low levels

of a serotonin metabolite (5HIAA) in the cerebrospinal fluid committed

suicide within two years. Apart from factors which contribute to chronic

suicidal risk, there are also factors which trigger an actual attempt, i.e.; a

recent loss, acute intoxication, unemployment, recent rejection, or failure.

There is much impairment from Lyme disease which increases suicidal risk

factors. However, suicidal tendencies associated with Lyme disease follow a

somewhat different pattern than is seen in other suicidal patients. In Lyme

patients, suicide is difficult to predict. At & shy;tempts are sometimes

associated with intrusive, aggressive, horrific images. Some attempts are very

determined and serious. Although a few attempts may be planned in advance,

most are of an impul & shy;sive nature. Both suicidal and homicidal tendencies

can be part of a Jarish-Herxheimer reaction.

 

I cannot emphasize enough the behavioral significance of the

Jarish-Herxheimer reaction. As part of this reaction, I have seen and heard

numer & shy;ous patients describe becoming suddenly aggressive without warning. I

can

appreciate skepticism regarding this statement. How can this be

ex & shy;plained? Like many other symptoms seen in Lyme disease, it challenges our

medical

capabilities. In view of this observation, I advise that antibiotic doses

be increased very gradually when suicidal or homicidal tendencies are part

of the illness.

 

Although I have discussed the significance of depression and suicide

associated with Lyme disease, I would like to treatment does help. Combined

treatment which addresses both the mental and somatic components of the

illness significantly improves the overall prognosis. This is supported by

clinical observation and laboratory research showing antidepressant treatment

improves immunocompetence. It has been demonstrated in vitro that

antidepressants which act on the serotonin 1A receptor (most

antidepres & shy;sants)

increase natural killer cell activity. In addition, there are undoubtedly

other indirect effects on the immune system through other neural or

neuroendurocrine and autonomic pathways. To state this more concisely -

antidepressants can result in antibiotic effects, and antibiotics can have

antidepressant

effects.

 

Most depression and suicidal tendencies often respond to treatment.

Suicide is a permanent response to a temporary problem. Many people who survive

very serious attempts go on to lead productive and gratifying lives.

Suffering can be reduced. The joy of life can be restored. Needless death can be

prevented. Don’t give up hope. There are answers, solutions, and assistance.

There is life after Lyme.

 

 

Articles Published in the Lyme Alliance Newsletter

By Robert C Bransfield, MD - several more articles about how Lyme effects

the brain,

_http://www.mentalhealthandillness.com/lymeArticles.htm_

(http://www.mentalhealthandillness.com/lymeArticles.htm)