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The singer revealed he’s received a diagnosis of Lyme disease. He’s bringing attention to the condition’s persistent symptoms that can affect physical and mental health — even after treatment with antibiotics. Getty Images
  • Singer Justin Bieber revealed he recently received a diagnosis of Lyme disease.
  • Lyme disease is a tick-borne illness that can cause fever, rash, joint pain, fatigue, and neurological problems.
  • Another common symptom people with Lyme disease experience is depression, which can appear both before, and linger long after, the illness is treated.
  • This can result in delayed diagnosis of Lyme disease for those who are already living with depression or other mental health conditions.

Singer Justin Bieber revealed last week that he recently received a diagnosis of Lyme disease, a tick-borne illness that can cause fever, rash, joint pain, fatigue, and neurological problems.

Bieber, 25, shared the news in an Instagram post, where he addressed comments people have recently made about his appearance. He also said in the post that he has a “serious case of ” that’s affected his brain function, energy, and overall health.

TMZ reports that Bieber’s Lyme disease caused depression and other symptoms, and that it went undiagnosed for much of last year.

Lyme disease is one of the most common tick-borne diseases in the United States. The bacterium Borrelia burgdorferi mainly causes it.

The Centers for Disease Control and Prevention (CDC) estimates 30,000 Americans contract it each year.

Many, but not all, people with B. burgdorferi develop a circular rash — which sometimes appears as a “bullseye” — within 3 to 30 days after being bitten by a tick carrying this bacterium.

Without prompt treatment, the bacterium can migrate from the bite area to other areas of the body, in particular the nervous system, heart, and joints.

This can lead to a range of persistent symptoms, including fatigue, night sweats, stiff neck, headache, disrupted sleep, and depression. These symptoms can last for months or years.

Some studies estimate that 10 to 20 percent of people still experience symptoms even after treatment with standard antibiotics. This condition is sometimes known as post-treatment Lyme disease syndrome (PTLDS).

Symptoms like fatigue, depression, anxiety, and brain fog aren’t unique to Lyme disease. But studies have found that 8 to 45 percent of people with PTLDS have depression.

Dr. John Aucott, director of the Johns Hopkins Lyme Disease Research Center in Baltimore, says depression among people with PTLDS tends to be mild to moderate in severity, with major depression uncommon.

In a 2017 study in Frontiers in Medicine, Aucott and his colleagues found that people with well-documented PTLDS had higher levels of depression — along with fatigue, pain, and poor sleep quality — than healthy participants.

Although major depression is less common in people with PTLDS, those with moderate to severe depression have a greater risk for suicidal thoughts.

Complicating matters, it’s not always easy for doctors to tell the difference between depressive symptoms that occur with Lyme disease and major depressive disorder.

“Our recent symptom survey could not distinguish Lyme and depression,” Aucott said. “Especially the vegetative symptoms, such as fatigue, sleep disruption, etc.”

However, one study found that people with PTLDS have more difficulty with memory-related tasks compared to people with major depression. And these memory problems can occur alongside language and attention difficulties.

So, do people with Lyme disease have depression because they have a chronic illness, or because of changes to their brain caused by the disease?

“We think both mechanisms are likely,” Aucott said.

In particular, researchers have been looking at inflammation caused by infection with B. burgdorferi as a possible cause of Lyme symptoms like fatigue and brain fog.

Aucott and his colleagues recently used PET imaging to scan the brains of 12 people with PTLDS.

They found higher levels of a protein called translocator protein (TSPO) in eight different regions of the participants’ brains compared to the brains of healthy people. This protein is a marker for brain inflammation.

Although the results will need to be replicated in larger studies, they fit with other research linking chronic inflammation with depression.

For Allie Cashel, president and co-founder of Suffering the Silence, an online community for people living with chronic illness and disability, the link between the long-term symptoms of Lyme disease — or any chronic illness — and mental health makes sense.

“When somebody is sick for a long period of time, their mental health is going to suffer,” Cashel said. “If someone is mentally ill for a long period of time, their physical health is likely going to suffer as well.”

For people with PTLDS, it can take years — and several doctors — before they finally get a diagnosis of Lyme disease.

People who are bitten by a tick may not even realize it. Or they may not develop the characteristic Lyme rash.

Also, years can pass between a tick bite and when people show up at their doctor’s office with symptoms like fatigue or brain fog.

When they do, their doctor may make a diagnosis of another condition, like depression or anxiety. While this can provide the clarity of having a definite condition, it may not bring relief of their symptoms.

If there were a reliable test for Lyme disease, these problems would probably go away. But right now, doctors don’t have a way to test for the presence of B. burgdorferi in blood.

Instead, they use antibody tests, which measure the immune system’s response to this bacterium. So, a person who has Lyme disease might test negative during the first month of infection if their immune system hasn’t produced a detectable level of antibodies.

Some studies also show that tests for Lyme disease aren’t always accurate and can sometimes lead to false results.

The lack of a clear diagnosis can leave people with PTLDS in limbo, constantly at a loss to explain why they feel so exhausted all the time.

Friends, family, and doctors may also doubt the truthfulness of their experience. Even the usually supportive people in their life — like a spouse or parent — may tell them that “it’s all in their head.”

Cashel received a diagnosis of Lyme disease when she was 7 years old after being bitten by a tick and developing the characteristic bullseye rash. After treatment with antibiotics she felt better, but she went on to experience years of serious pain, fatigue, and neurological problems.

She also found herself struggling for those around her to believe her, including a number of doctors.

“Depression for people often comes — and came for me at least — just by virtue of experiencing such debilitating symptoms over such a long period of time, and often facing a lot of dismissal over the course of their treatment and diagnosis journey,” Cashel said.

With the rapid spread of Lyme disease and other tick-borne diseases — which the CDC says may be due to changes in land use or climate — more doctors are aware of the complex symptoms that can occur in Lyme disease.

The nonprofit International Lyme and Associated Diseases Society has a directory of physicians trained to treat complex tick-borne diseases.

The Bay Area Lyme Foundation also lists laboratories that will test ticks for Lyme and other diseases.

Still, more research is needed to fully understand the link between Lyme disease and depression. But some doctors say that dealing with psychological problems — whatever their cause — can promote recovery.

Cashel says one of the things her organization encourages people to do is to own all aspects of their experience of illness — including the physical and mental.

“If you are experiencing chronic pain or you’ve been diagnosed with Lyme after a 15-year battle of trying to find a diagnosis, it’s important to acknowledge the mental health struggle and how difficult it’s likely been,” Cashel said.

“In doing that and speaking about their illness more openly, it’s my hope that people will be able to recover from that trauma a little bit easier,” she said.