At Internal Medicine Grand Rounds on February 14, 2002, Allen C. Steere,
MD, discussed a 58-year-old man with chronic Lyme disease.1 The
patient, Mr C, described 10 years of symptoms following spending time on Martha's
Vineyard, an area endemic for Lyme disease. He reported an episode of left-sided
Bell's palsy and subsequently noted that he was less competent mentally and
that he had developed numerous physical symptoms including neck pain, back
pain, joint aches, periodic blurred vision, and periodic sweats. He was treated
for Lyme disease with an initial course of tetracycline and his symptoms improved.
However, his symptoms returned a few years later, and he received multiple
subsequent courses of antibiotics for Lyme disease. In late 1999, due to a
change in his insurance, Mr C transferred to a new primary care physician,
Dr N. His new physician was not convinced of the benefit of recurrent courses
of antibiotics and wondered whether Mr C was suffering from depression. He
prescribed paroxetine, 20 mg/d. On that regimen, Mr C noted less anxiety,
less joint pain, and improved cognition. He was also sleeping better.