Why Can’t I Get Better?

Solving the mystery of lyme and chronic disease

Are My Anxiety and Depression Due to Lyme Disease?

Tick-borne illnesses imitate common disorders and worsen psychological symptoms.

Lyme disease is known as “the great imitator” and is now spreading worldwide in epidemic proportions, mimicking every known medical condition seen in a doctor’s office. I have seen over 12,000 chronic Lyme disease patients come through my medical center in the last 26 years, and often they tell me the same story: “Doctor, I’ve been to 10-20 physicians in the last several years, always complaining of the same symptoms and no one is able to tell me what is wrong with me. I’m tired. I have aches and pains as well as tingling, numbness and burning sensations all over my body that come and go and migrate. I have headaches and a stiff neck. The light bothers my eyes, and I’m sensitive to sound. I’m often dizzy. My memory doesn’t work and I can’t concentrate. I have chest pain, palpitations and shortness of breath. I have sleep problems where I can’t fall asleep or frequently wake up in the middle of the night, often with associated sweats and chills. I’m depressed and anxious. The doctors have tried to find a reason for my symptoms, but all of my blood tests are negative. They’ve told me that I have Chronic Fatigue Syndrome (CFS/Myalgic encephalomyelitis), Fibromyalgia, an autoimmune disorder like rheumatoid arthritis, lupus, or MS, or that it’s all in my head. I’m now on medicine for my anxiety and depression, and I’m still not feeling well. Is there anything else that I can do?”

If you are reading the above clinical history and are saying to yourself: “I have many of those symptoms!” you may be suffering from Lyme disease and associated tick-borne infections. Lyme disease is acquired through the bite of an infected tick which contains a bacterium known as Borrelia burgdorferi. Ticks also contain a myriad of other bacteria, parasites and viruses that can make you sick. For example, Babesia microti, a malaria type parasite, is also found in ticks, and is frequently found in patients with chronic Lyme disease who do not improve with standard antibiotic therapies. These patients often complain of day sweats, night sweats and chills, and are three times sicker than the average patient with Lyme disease. Their depression, anxiety and other psychiatric symptoms are also much worse when they have Babesia and Lyme together. So why hasn’t your doctor been able to make the diagnosis and help you?

The blood tests for Lyme disease have been shown to be unreliable. Doctors have been taught to do a two-step blood test, using an ELISA test followed by a Western Blot to establish the presence of the bacteria. These tests have been shown to be very insensitive, and miss at least half of the cases of Lyme disease. There are also over 100 strains of borrelia in the US and over 300 strains worldwide, and no commercially available test is going to pick up the presence of all of these different bacteria. Finally, the Lyme organism can hide from the immune system, where the standard antibody tests fail to pick it up. What can you therefore do to see if your psychological symptoms are due to Lyme disease?

Lyme disease is a multisystemic illness. If you have a cluster of classic presenting symptoms, including fatigue, joint and muscle pain, neuropathic pain (tingling, numbness and burning), sleep disorders, memory and concentration problems, as well as anxiety and/or depression, there is a good possibility that you suffer from a tick-borne disorder. Although these same symptoms can overlap other diseases, there are certain classic symptoms which point towards Lyme. Lyme disease symptoms tend to come and go with good and bad days. The joint and muscle pain as well as the neuropathic pain tend to migrate around the body. These symptoms may improve with antibiotic therapy, or worsen with antibiotics (a Jarish-Herxheimer reaction when the bacteria is being killed off), and women often report an increase in symptoms right before, during, or after their menstrual cycle. If you have also had a Lyme Western Blot which showed any one the following borrelia specific bands/proteins: 23, 31, 34, 39 and/or 83-93, and other diseases have been ruled out, then Lyme disease is likely.

Lyme disease can mimic many psychiatric and cognitive disorders, and increase the severity of prior underlying symptoms. Patients in my practice who score high on standardized tests for depression and anxiety often return to near normal scores when their Lyme disease and co-infections are treated successfully. Get your health care provider to screen you for Lyme disease. The only thing that might be in your head is bacteria making you sick.

 

Dr Richard Horowitz

Dr Richard Horowitz is the author of the recently released book “Why Can’t I Get Better? Solving the Mystery of Lyme and Chronic Disease”, available through St Martin’s press.

http://www.amazon.com/Why-Cant-Get-Better-Solving/dp/1250019400

www.cangetbetter.com

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Fallon, B.A, Kochevar, J.M., Gaito, A., and Nields, J.A. The underdiagnosis of neuropsychiatric Lyme disease in children and adults. Psychiatric Clinics of North America. 1998; 21: 693-703;

Fallon, B.A. and Nields, J.A. Lyme Disease: A neuropsychiatric illness Am J Psychiatry. 1994Nov; 151(11):1571-83;

Hajek, T., Paskova, B., Janovska, D., et al. Higher prevalence of antibodies to Borrelia Burgdorferi in psychiatric patients than in healthy subjects. Am J Psychiatry 159:297-301, February 2002;

Cameron, Horowitz, et al. Evidence-based guidelines for the management of Lyme Disease. Expert Review of Anti Infective Therapy 2(1) 2004

Shadick, N. A. et al. Musculoskeletal and neurologic outcomes in patients with previously treated Lyme disease. Annals of Internal Medicine, 1999, 131 (12), 919-926.

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Marangoni A, Sparacino M, Cavrini F, Storni E, Mondardini V, Sambri V, Cevenini R. Comparative evaluation of three different ELISA methods for the diagnosis of early culture-confirmed Lyme disease in Italy. J Med Microbiol. 2005 Apr;54(Pt 4):361-7.

Kaiser R. False-negative serology in patients with neuroborreliosis and the value of employing of different borrelial strains in serological assays. J Med Microbiol. 2000

Schutzer SE, Coyle PK, Belman AL, Golightly MG, Drulle J. Sequestration of antibody to Borrelia burgdorferi in immune complexes in seronegative Lyme disease. Lancet. 1990 Feb 10;335(8685):312-5; 

Steere AC. Seronegative Lyme disease. JAMA. 1993 Sep 15;270(11):1369; 

Krause, PJ., et  al. Concurrent Lyme Disease and Babesiosis Evidence for Increased Severity and Duration of Illness.  JAMA 1996; 275(21):1657-1660.

 

 

 

Richard Horowitz, MD, is a board certified internist in private practice in Hyde Park, N.Y.

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