Depression, and Suicide
By Robert C.
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 papilledema, 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 referred
to a psychiatrist. However, I was never comfortable labeling her condition as
just another 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 arthritis outbreak in
In my database, depression is the most common
psychiatric syndrome associated with late stage Lyme disease. Although
depression is common in any chronic illness, it is more prevalent with Lyme
patients than in most other chronic illnesses. There appears to be multiple
causes, including a number of psychological and physical factors.
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 disease. In
contrast, multi-system diseases such as Lyme, depression,
disease can penetrate into multiple aspects of a person’s life. It is
escape for periodic recovery. In many cases, this results in a vicious 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.
Endocrine disorders such as hypothyroidism, which cause depression, are
sometimes associated with Lyme disease and further strengthen the link between
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 functions. 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 development 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 statistical 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 consequences, such as suicide.
Suicidal tendencies are common in neuropsychiatric
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 approximately 1/3 of
Lyme encephalopathy patients. Homicidal tendencies are less common, and occurred
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 associated with an inability to appreciate the pleasure of
I cannot emphasize enough the behavioral significance
of the Jarish-Herxheimer reaction. As part of this reaction, I have seen and
heard numerous patients describe becoming suddenly aggressive without warning.
I can appreciate skepticism regarding this statement. How can this be explained?
Like many other symptoms seen in Lyme disease, it challenges our medical
capabilities. In view of this observation, I advise that antibiotic
increased very gradually when suicidal or homicidal tendencies are part of the
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
antidepressants) 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
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.