Finding an engorged, blood-sucking tick attached to your skin can cause anxiety in and of itself. After all, Lyme disease, an infection that causes multi-systemic, waxing-and-waning symptoms, and a disease that isn't always detected or effectively treated early on, is on the rise. But researchers are starting to realize that, although getting bitten may be stressful, tick-borne infections could actually trigger panic attacks and other psychiatric disorders in some people. "After treating thousands of patients with tick-borne disease in the past 20 years, it appears psychiatric symptoms are more commonly seen when there is a co-infection," explains psychiatrist Robert Bransfield, MD, former president of the International Lyme and Associated Diseases Society (ILADS) and president of the New Jersey Psychiatric Association. Co-infections (when a tick passes along more than one disease) most often involve Lyme, babesiosis, a malaria-like infection that can cause fever, night sweats, and anemia; and bartonella (cat scratch fever), a bacterial infection that causes fever, headache, and raised skin rashes. Co-infections are most often culprits in tick-related panic attacks and anxiety, and these multiple infections from tick bites are quite common, occurring in an estimated 30 percent of cases.
Dr. Bransfield, who is also associate director of psychiatry at Riverview Medical Center in New Jersey (a state with a high prevalence of Lyme disease), points out that 240 peer-reviewed scientific articles demonstrate an association between Lyme and other tick-borne diseases and mental illness. For instance, a small study published in The Clinical Journal of Pain in 2005 found that patients experiencing panic attacks also suffered other symptoms not typical of standard panic attacks—extreme sensitivity to light, touch, and sounds, joint pain, mental fogginess, and migrating pain, all of which can be symptoms of Lyme disease—and those people tested positive for Lyme and babesiosis, which, like Lyme, is on the rise in the U.S. Once treated with antibiotics for both diseases, the patients no longer experienced panic attacks.
Another study published in the American Journal of Psychiatry in 1994 found that 40 percent of patients with Lyme disease develop neurological impairment, which may not surface for months or years after a tick bite. Psychiatric reactions included not only panic attacks, but also bipolar disorder, schizophrenia, dementia, obsessive-compulsive disorder, anorexia, and depression.
"Many of the psychiatric symptoms of Lyme and associated tick-borne diseases are mediated by immune mechanisms," Dr. Bransfield explains, adding that the in Lyme sufferers, the immune system gets thrown out of whack. Furthermore, things like infection and stress can weaken and provoke the immune system, causing chronic inflammation, which has been linked to mental disorders. Ultimately, there needs to be better interaction between infectious disease specialists, immunologists, and mental health practitioners, Dr. Bransfield says.
Tick-borne diseases could, quite literally, push you over the psychological edge. And although other insect-borne diseases like West Nile virus may garner more headlines, you're far more likely to be sickened by a tick, according to U.S. Centers for Disease Control and Prevention statistics. For instance, 2009 saw 720 cases of West Nile virus, while nearly 40,000 probable cases of Lyme disease occurred that year. (Many doctors specializing in Lyme treatment believe Lyme disease numbers could be much higher because tests detecting the disease are not very reliable.)
Here's how to gauge whether your anxiety is linked to Lyme disease or other tick-borne diseases:
• Know how different panic attacks work. Panic attacks spurred by Lyme disease or other tick-borne infections are generally different than non-infectious-based panic attacks, explains Dr. Bransfield. A regular panic attack lasts a few minutes, but he says those brought on by tick-related ailments can go on for more than a half hour. If your panic attack symptoms grow worse while on once-effective antianxiety treatment, it's another sign that Lyme or a related infection could be causing the attacks.
• Know when to consider tick-borne diseases. Don't rely on finding a tick attached to your body to gauge your Lyme disease risk: Many people don’t recall being bitten at all, while others notice migrating rashes or red or black-and-blue splotches shortly after being bitten. Other early Lyme symptoms sometimes pop up a few days to a month after infection and include fatigue, fever, and chills. If the disease becomes more established in your body, it could cause cardiac and neurological problems. If you think you've been recently infected with Lyme, ask your doctor to perform blood tests, and if negative, have them repeated about six weeks later. If the results are still negative and you still suspect Lyme, you may want to see a doctor who specializes in treating Lyme aggressively. Doctors should first test to rule out other conditions with similar symptoms.
• Fight with your doctor if you need to. Lyme disease is a contentious subject, with two different schools of thought: Some consider to be a short-term infection, others believe it can be chronic. Some doctors take the threat of chronic Lyme seriously, and believe it should be treated with longer courses of antibiotics; others believe chronic Lyme doesn't exist. (Read Lyme Hearing Highlights a Broken System and Lyme Disease Treatment Guidelines: All Wrong? for more background.) Until more doctors recognize the severity of the disease, if you believe you have Lyme it's best to advocate for a clinical diagnosis using the strategy above.
Here are three steps to keep Lyme disease from driving you crazy in the first place:
• Scan daily. You slash your risk of developing Lyme disease if you scan your body daily for ticks. Use a mirror or a partner to check hard-to-see places, and pay special attention to areas where ticks like to hide—armpits, bra and panty lines, and the groin. And don't forget to keep your pet free of ticks naturally, too.
• Scrub-a-dub-dub. Bath time presents a great opportunity for Lyme prevention because of these three things:
1. It's another chance to focus on your body and check for ticks.
2. You can wash off ticks that haven't attached yet.
3. You may take off clothing ticks were hanging onto.
For the best protection, take a shower within two hours of being outside.
• Don't rely on a bull's eye or blood tests. While many people associate a bull's eye rash with Lyme disease, only about 30 percent of people who contract the infection show the telltale symptom. Blood tests are also unreliable, and many doctors specializing in Lyme treatment believe clinical diagnosis is more effective than blood tests alone. "The science surrounding testing and the interpretation of currently available tests is a complex subject," says Dr. Bransfield. "Negative tests may occur when infection is present; there is no currently available test that can reliably rule out the presence of tick-borne disease."
If your family doctor has ruled out other health issues and you still believe you have Lyme disease or another tick-borne disease, join Lyme support groups and ask for doctor recommendations.