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Suicide & Lyme & Associated Diseases

Key Messages

Suicide is a major and potentially preventable public health concern. It is the result of an interaction between known and unknown contributors, deterrents, and acute triggers.
Studies have demonstrated that increases in suicidality can be attributed to infections and associated proinflammatory cytokines, inflammatory-mediated metabolic changes, and quinolinic acid and glutamate changes that affect the neural circuitry.
Research has suggested that there is a strong association between inflammation, brain inflammation, elevated cytokine levels, and suicide. Lyme and Associated Diseases (LAD) causes immune-mediated …

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Background

The following is a summary of Bransfield, R. Suicide and Lyme and Associated Diseases. Neuropsychiatric Disease and Treatment. 2017:13;1575-1587, which was developed independently of the article authors.

  • Borrelia burgdorferi is associated with the diagnosis of Lyme’s Disease, but other tick-borne coinfections along with opportunistic infections can also be diagnosed with Lyme’s Disease, which can be explained by using the term “and associated diseases”.
  • Once patients with Lyme disease develop depression, symptoms of depression can be persistent along with psychiatric symptoms even if antibiotic treatment has been initiated.
  • The International Lyme and Associated Diseases Society (ILADS), American Psychiatric Association (APA), and Infectious Disease Society of America (IDSA) provide guidelines in addressing and diagnosing Lyme Disease.

Purpose

  • Retrospective chart review with epidemiological calculation of the association between suicide and LAD.

Methodology

  • The study included 253 inactive charts of patients with LAD. Charts were divided into four groups which were: suicidal and homicidal, suicidal not homicidal, experiencing explosive anger not suicidal or homicidal, and not suicidal, homicidal, or experiencing explosive anger.
  • Indirect method to estimate the possible prevalence of suicidality associated with LAD by using Center for Disease Control Prevention (CDC) statistics along with other medical literature.
  • There was an average of 8 years before diagnosis and initiation of treatment for LAD.

Results & Implications

  • The study showed 68% (N=172) of patients with LAD were suicidal, homicidal, and/or had explosive anger. Within this group, 43% (N=110) were suicidal, 32% (N=81) were suicidal not homicidal, and 11% (N=29) were both suicidal and homicidal.
  • When examining all the patients, 10% of the patients had preexisting depression and after infection 97% of the group had depression.
  • There is no record of numbers of LAD patients who commit suicide. Based on indirect method of calculation using the CDC and other previous studies statistics, the study found the suicidality ratio of 0.3% which correlated to 1,244 suicides, 14,928 self-harm events, and 31,100 suicide attempts, and 414,540 patients with suicidal ideations in the US per year from LAD.
  • The authors suggested that patients with LAD should be assessed for risk of suicide due to reports of suicide along with depression, anxiety, brain fog, paranoia, loss of mental capacities, and other mental symptoms reported in the Lyme vaccine clinical trial.
  • Over 300 peer-reviewed international journal articles have documented the association of psychiatric symptoms with LAD. Specifically, depression prevalence is higher in later stages of LAD which could be a contributor for suicidal risk.

Conclusion

  • Multiple studies have found that LAD is associated with increased risk of depression and intrusive symptoms which are associated with increased risk of suicide.
  • The authors concluded that suicide risk was higher in outdoor workers and veterans due to environmental exposure to LAD and encouraged medical examiners, the CDC, and other epidemiological organizations to proactively assess the association of LAD and suicide.