Is There a Connection Between Lyme Disease and Mental Illness in Teens?

Last month, I wrote a post describing Diane, a teenage girl suffering from anorexia nervosa.¹ As it turned out, she had Lyme disease and had three tick-borne coinfections: Babesia, Bartonella, and Mycoplasma. She responded to antibiotics and three years later she still has no evidence of an eating disorder.

Dr. Nancy Brown, a colleague, was in my office during one of Diane’s appointments. I commented to her, “Wouldn’t it be great if we could test a group of people who suffer from anorexia nervosa for tick-borne infections?”

“Well,” she told me, “I’m the medical consultant at a residential treatment center for adolescents with mental health issues. Let’s see if I can get permission to do this.”

We did receive cooperation from the residential center. In addition, IGeneX Laboratory agreed to test patients free of charge for Lyme, Bartonella, and TBRF—tick-borne relapsing fever. Moleculera Labs also generously agreed to test our patients to the Cunningham Panel.

It was not difficult to get 10 volunteers at the residential center. None had eating disorders, since the center was not equipped to deal with that, but all 10 were diagnosed with DSM-5 Major Depressive Disorder; 7 were additionally diagnosed with Generalized Anxiety Disorder, and 3 had made serious suicide attempts.

With the exception of one subject previously diagnosed with celiac disease, none had a known physical disorder. All of these teens had severe psychological dysfunction requiring intensive residential treatment—they could not hack it at home or go to school.

Here is what we found²:

• Lyme disease immunoblot was positive by IGeneX criteria for 3 teens.
• A more liberal interpretation of the test results, consistent with analysis by most Lyme docs, indicated 9 had antibodies to Lyme.
• Antibodies to Bartonella were detected in 3, and borderline positive in a fourth.
• Antibodies to TBRF were detected in 4 subjects, and borderline positive in another two.
• Antibodies to Streptococcus were detected in 3 subjects, and borderline positive in a fourth.
• The Cunningham Panel was positive in 9 of the 10 teens.

In all likelihood, 9 of 10 had antibodies to tick-borne infections. And 9 of 10 had evidence of autoimmune encephalitis.

Autoimmune encephalitis is the medical term for "brain on fire" inflammation in the brain that can result in serious mood, behavioral and cognitive disorders. The Cunningham Panel is a test for antibodies against the nervous system.

Susan Swedo at the National Institute of Mental Health first described this condition in children who developed neuropsychiatric symptoms shortly after a strep infection, and she termed it Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections—PANDAS.^3,4

Not long afterward, it became clear that multiple microbes other than Streptococcus can trigger autoimmune encephalitis, and the name was broadened to Pediatric Acute-onset Neuropsychiatric Syndrome — PANS.

The microbes that thus far have been shown to trigger PANS include several viruses including Epstein-Barr, the common cold, influenza, and chickenpox as well as Bartonella, Mycoplasma, and mold.^5-7 There was a recent report out of Italy describing two boys in whom SARS-CoV-2, the virus that causes COVID-19, triggered PANS.⁸ It is likely, but not clear at this time, that Borrelia burgdorferi, the Lyme pathogen, also triggers PANS.

In 2013, the PANS collaborative consortium published criteria for the diagnosis of PANS.⁹ These include the sudden onset of obsessive-compulsive disorder (OCD) or severely restricted food intake, without a known medical disorder that would account for these symptoms. In addition, the case definition requires two of the following seven criteria to make the diagnosis:

• Anxiety
• Emotional lability or depression
• Irritability, aggression, and/or oppositional behavior
• Behavioral (developmental) regression
• Sudden deterioration in school performance
• Motor or sensory abnormalities including tics and involuntary movements
• Somatic signs and symptoms—like sleep disturbances and bedwetting

Eating Disorders Essential Reads

Hope and Hesitation in the Journey of Anorexia Recovery

Binge Eating Disorder: Struggling in Silence

It is important to have clear diagnostic criteria so that researchers studying this condition are always studying the same population of subjects, but not all kids with autoimmune encephalitis will fulfill these criteria. In particular, many of my patients do not have an acute—i.e, sudden—onset of their symptoms; the onset may be stuttering or slow.

According to the National Institutes of Mental Health, nearly one-third of all adolescents ages 13 to 18 will experience an anxiety disorder, and 8% of those will become severely impaired.¹⁰ The NIMH also reported that the prevalence of major depressive disorder in adolescents in 2017 was 13.3%, with nearly three-quarters of those becoming severely impaired.¹¹ Suicide has replaced homicide as the second most common cause of death for teenagers ages 10 to 19 in the United States.¹²

In other words, we have an epidemic of mental illness in adolescents.

Our investigation was small. Ten adolescents picked at random with mental illness severe enough that they required institutionalization—9 of 10 had evidence of tick-borne infections and 9 of 10 had evidence of autoimmune encephalitis.

Clearly, there is a need for more investigation, but I suspect that many of the teens afflicted with mental illness in the U.S. are suffering from brains on fire. Their illness may present as emotional, but the cause may be organic. In the next installment, I will discuss the diagnosis and treatment of PANS.