By Daniel A Kinderlehrer, MD

Those of us dealing with Lyme disease are well aware that most symptoms reside in the musculoskeletal and nervous systems. And for many of us, the worst symptoms in the nervous system are neuropsychiatric. The severity of anxiety, panic attacks, depression, irritability and rage can be overwhelming.

Chronic tick-borne infections can also cause bipolar disease, addiction syndromes, eating disorders, obsessive compulsive disorder and psychosis.^1-8 And of course, it is all compounded by impaired sleep, brain fog, fatigue and chronic pain, not to mention physician ignorance.

Neuroinflammation

It turns out that these mental health symptoms are primarily caused by inflammation from infection outside the nervous system.⁹

For example, kids with PANS—Pediatric Acute-onset Neuropsychiatric Syndrome—have infections in which antibodies to different microbes cross the blood brain barrier and attack the brain, resulting in severe mood and behavioral disturbances.¹⁰ A similar process occurs in adults with neuropsychiatric Lyme disease.^11-13

There is increasing recognition that many mood disorders are linked to infections and autoimmune disorders, and the common link is neuroinflammation—brain on fire.¹⁴

It is no surprise that people with neuropsychiatric Lyme disease have elevated levels of inflammatory mediators including antineuronal antibodies, cytokines, chemokines and inflammatory lipoproteins.⁹  Think of neuropsychiatric Lyme disease as autoimmune inflammation of the brain. The primary legs of treatment are antimicrobials, psychotropic medications and anti-inflammatory agents. Ideally, an anti-inflammatory agent will decrease inflammation but not suppress immune function.

In March 2023, I published a report describing a patient with long standing Lyme disease, Babesia and Bartonella infections in which the primary symptoms were neuropsychiatric.¹⁵ He experienced anxiety with panic attacks, depression with suicidal ideation and sleeplessness.

These symptoms gradually came under control with appropriate treatment, but a change in his regimen resulted in a severe relapse. He could no longer tolerate even low dose antimicrobials without Herxheimer reactions, Zoloft was not helping and he could not tolerate Ativan for anxiety. In fact, any benzodiazepine increased his suicidality. That is when his daughter suggested he try microdosing.

A new approach: psychedelic microdosing

This is from the case study that I published:

After a 40-year prohibition in the US of lysergic acid diethylamide (LSD) and psilocybin, there has been renewed interest in their potential for therapeutic benefit. The preponderance of research in the past two decades has been in controlled clinical settings in which subjects are administered a single high dose of a hallucinogen while under the supervision of a therapist/guide. In 2018 the US Food and Drug Administration categorized psilocybin as ‘a breakthrough therapy’ in the treatment of depression, a designation the agency applies to drugs that in early trials demonstrate substantial improvement over existing treatments.¹⁶

There is compelling evidence that psilocybin has potential value in the treatment of some mental health conditions. Multiple studies have documented its effectiveness in patients with depression, anxiety syndromes, end of life anxiety, and suggested benefit in OCD and addiction disorders.^17-23

Microdosing is the practice of consuming very low, sub-hallucinogenic doses of a psychedelic substance on a regular basis. The intention of microdosing is to offer similar benefits to full dose psychedelic therapy, but without perceptual distortions, the need for clinical oversight, or the risk of a bad trip.” ²⁴

Microdosing has become increasingly popular. In one online microdosing forum that was begun in 2013, the number of subscribers rose to 40,000 in 2018 and 219,000 in October 2022.²⁵ LSD and psilocybin continue to be listed as schedule 1 controlled substances, meaning legally they have no accepted therapeutic value. Nevertheless, possession of psilocybin has been decriminalized in many US cities and is on the ballot of many states to be legalized in clinical therapeutic settings; Oregon and Colorado have already done so.²⁶

No longer suicidal

The subject of my case history began microdosing three times weekly at doses one-fiftieth of a typical hallucinogenic journey. Within two days he was no longer suicidal and within two weeks he felt well. He continues to microdose and feels well three years later.

No wonder they call psilocybin magic mushrooms. It is a potent stimulator of serotonin and may also have some influence on dopamine.²⁷ But what may be more crucial is its anti-inflammatory action. It significantly inhibits pro-inflammatory cytokines such as tumor necrosis factor-alpha, interleukins IL-1b, and IL-6, and cyclooxygenase-2 concentrations in human macrophage cells.^28-30

It turns out that most mental health disorders are caused by neuroinflammation. That’s right: most patients with anxiety, depression, bipolar disorder and even psychosis have inflammation in their brains driving their mood disorders.³¹

Neuroinflammation in these patients may be caused by undiagnosed tick-borne infections, but there are multiple other drivers of inflammation. Autoimmune diseases such as lupus, Sjögrens syndrome, rheumatoid arthritis and multiple sclerosis are well documented causes of neuropsychiatric illness.^32-37  Stress by itself can result in inflammatory conditions.³⁸ People with childhood histories of adverse events such as physical or sexual abuse have an increased risk of autoimmune problems.³⁹

Patients with PTSD—Post Traumatic Stress Disorder—don’t just have hypervigilance and anxiety disorders. They develop the same nervous, immune and endocrine system dysregulation as patients with persistent tick-borne infections and neuropsychiatric disease.⁴⁰

The role of genetics

Meanwhile, genetics plays a significant role in the development of autoimmune conditions. Add to this epigenetic transmission that alters gene expression without changing the underlying DNA expression, and allows for trauma to be handed down from one generation to the next⁴¹—just ask children and grandchildren of Holocaust survivors.

Microdosing psilocybin holds the potential to help patients suffering from these mental health issues. Numerous studies suggest that microdosing is effective in the treatment of anxiety and depression.^42-46 Unfortunately, these studies are not controlled and are reliant on subject reporting—it is impossible to separate benefits from placebo effect. We clearly need better research on microdosing.

Presently Johns Hopkins University is recruiting for a study in which patients with PTLDS—Post Treatment Lyme Disease Syndrome—are treated with full hallucinogenic doses of psilocybin under the supervision of a therapist/guide.⁴⁷ These ‘journeys’ last four or more hours in controlled settings. I hope this research finds positive benefits of treatment, but full dose psilocybin treatment demands excessive resources that will never be available to most patients with Lyme.

Those of us with chronic Lyme know that PTLDS is actually persistent infection with Borrelia burgdorferi complicated by the existence of co-infections resulting in systemic inflammation—it is an autoimmune illness.⁴⁸ In a review of the physiological effects of psychedelics, the authors Caitlin Thompson and Attila Szabo “…propose that psychedelics hold the potential to attenuate or even resolve autoimmunity.”

The bottom line is that microdosed psilocybin may be an important adjunct to the treatment of mental illness. It is time that we find the resources to perform properly controlled double-blind investigations into the impact of microdosed psilocybin on patients with neuropsychiatric Lyme disease as well as those suffering from the ever-increasing numbers suffering from mental health disorders.

Click here to read the entire case report.

Dr. Daniel Kinderlehrer is an internal medicine physician in Denver, Colorado, with a practice devoted to treating patients with tick-borne illness. He is the author of  Recovery From Lyme Disease: The Integrative Medicine Guide to the Diagnosis and Treatment of Tick-Borne Illness.

References

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