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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The author describes the histories of three patients with panic-like episodes that turned out to be related to underlying, previously unsuspected tick-borne diseases. Each woman experienced symptoms that are not usual in panic disorder but are typical of neurological Lyme disease, including exquisite sensitivity to light, touch, and sounds, joint pain often in combination with cognitive changes including mental fogginess and loss of recent memory, and some degree of bizarre, shifting, and often excruciating neurological pain. Because these symptoms are atypical of primary panic disorder, they were very helpful in alerting the clinician to suspect an underlying physical illness. In each case, the results of testing revealed positive hallmarks of disseminated Lyme and other tick-borne diseases, including Lyme borreliosis caused by the spirochete, Borrelia burgdorferi, babesiosis, and ehrlichiosis. Since beginning treatment with intensive doses of appropriate antimicrobial medications for their tick-borne infections, all three patients have become free of panic attacks. Treatment of their infections by a specialist in Lyme disease allowed one of the women to discontinue anti-anxiety medication completely and another to reduce the dose of medication to occasional use only. The third patient is no longer anxious but her depression is resolving more slowly despite the ongoing use of an antidepressant. Two of the patients have also needed ongoing medication for pain and other symptoms of late-stage, neurological Lyme disease.
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PMID:Panic attacks may reveal previously unsuspected chronic disseminated lyme disease. 1599 Apr 95

Chronic pain is a frequent component of many neurological disorders, affecting 20-40% of patients for many primary neurological diseases. These diseases result from a wide range of pathophysiologies including traumatic injury to the central nervous system, neurodegeneration and neuroinflammation, and exploring the aetiology of pain in these disorders is an opportunity to achieve new insight into pain processing. Whether pain originates in the central or peripheral nervous system, it frequently becomes centralized through maladaptive responses within the central nervous system that can profoundly alter brain systems and thereby behaviour (e.g. depression). Chronic pain should thus be considered a brain disease in which alterations in neural networks affect multiple aspects of brain function, structure and chemistry. The study and treatment of this disease is greatly complicated by the lack of objective measures for either the symptoms or the underlying mechanisms of chronic pain. In pain associated with neurological disease, it is sometimes difficult to obtain even a subjective evaluation of pain, as is the case for patients in a vegetative state or end-stage Alzheimer's disease. It is critical that neurologists become more involved in chronic pain treatment and research (already significant in the fields of migraine and peripheral neuropathies). To achieve this goal, greater efforts are needed to enhance training for neurologists in pain treatment and promote greater interest in the field. This review describes examples of pain in different neurological diseases including primary neurological pain conditions, discusses the therapeutic potential of brain-targeted therapies and highlights the need for objective measures of pain.
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PMID:Neurological diseases and pain. 2206 41