When you’re not feeling well you want, and need, solutions. Learn about a variety of strategies that may help you manage your symptoms.
How can I manage my Lyme disease symptoms?
Lyme disease should always be treated with an appropriate course of antibiotics as prescribed by a knowledgeable medical practitioner. Some people continue to experience a variety of symptoms despite appropriate antibiotic treatment. Many of these symptoms can drag you down and negatively affect your quality of life.
The strategies we describe below can help you manage your symptoms, from fatigue and brain fog to pain and sensory sensitivities. These recommendations are aimed at helping you feel better and do not treat Lyme disease.
In addition, few of these strategies have been adequately studied in people with Lyme disease. Some have been studied in people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), fibromyalgia, or long COVID, whose symptoms can be similar to those of Lyme disease. However, even in these other illnesses, there is limited data regarding the effectiveness of these treatments and strategies. Ongoing studies continue to evaluate some of these treatments.
We will focus on a range of approaches, from things you can do on your own, such as practicing mind-body therapies and getting adequate rest, to medications that require a doctor’s prescription. When you’re not feeling well you want, and need, solutions as quickly as possible and it can be hard to be patient. It may take trial and error — and time — to find the approaches that help you.
Healthy lifestyle practices like eating well, getting enough rest, and managing stress are always important. If you try specific techniques, like acupuncture or supplements, it’s a good idea to try them one at a time. This way you can get a clear picture of what works for you and what doesn’t. The same is true of medications. It may be helpful to keep a journal of what you try and how it makes you feel.
If you decide to try any of the strategies below, be sure to discuss them with your doctor in a collaborative way, even if you’re trying something that doesn’t need a prescription or referral. And make sure you understand not only the potential benefits but also the possible risks to you, the cost, and the expected length of treatment or therapy.
Healthy lifestyle practices
These general wellness practices provide a strong foundation for your health whether you are feeling well or ill.
May help with symptoms including: depression, lethargy, fatigue, pain, poor balance, sleep disturbances, and weakness.
When you’re not feeling well, it can be hard to be physically active. Over time, your body can become deconditioned from illness. Your exercise tolerance will depend on many things including your current stamina, how fit you were before you got sick, and whether your Lyme disease and other factors that affect your health, such as sleep and diet, have been adequately addressed. As you’re able, try to slowly get back into an exercise routine.
Start with very small low-impact efforts, like stretching, taking a five-minute walk, or doing a short bout of aquatic exercise, and see how those make you feel. If you can tolerate that exercise and don’t feel worse afterward (a phenomenon known as post-exertional malaise, or PEM, which can set in 24 to 72 hours after exercise), you can try slowly increasing your activity. Build in enough time for rest and recovery. As tolerated, you can gradually work up to mild- to moderate-intensity aerobic and weight-bearing exercise. It may help to work with a physical therapist, particularly one who has experience helping people recondition after illness and is familiar with PEM. You can ask your doctor to refer you to a physical therapist.
If you do experience PEM, you will need to be cautious about your activity. Pace yourself and limit your activity to avoid worsening of your symptoms. Aggressive exercise in this situation could result in a significant setback.
Mind-body therapies stimulate the body’s parasympathetic, or relaxation response, the deep physiological shift in the body that counters the stress response. Some can be done on your own at home, and some can be guided through an app or a class. Those that involve physical exercise should be done slowly, as tolerated, with time built in for rest and recovery (see: Exercise).
Mind-body therapies may help with symptoms including: anxiety, concentration issues, depression, fatigue, mood swings, pain, poor balance, sleep disturbances, and stress.
Your breath can have a direct effect on your body. Slow, rhythmic breathing quiets down your autonomic nervous system, promoting a more balanced, relaxed state. Your heart rate slows, and hormones that encourage feelings of calm increase. Breathing deeply from your diaphragm can help you relax. You might try lying down with one hand on your chest and one on your stomach, breathing so that only the hand on your stomach moves. You might think to yourself, “Breathe in…breathe out.” Other breathing exercises include “triangle” breathing (inhale for three seconds, hold for three seconds, exhale for three seconds); or alternate nostril breathing (close one nostril with a finger or thumb for 5 to 10 breaths, then switch).
Meditation involves practices that focus the mind and connect it to the breath and body to produce physical and mental effects. The practice of meditation cultivates mindfulness, awareness and attention, typically by focusing on your breathing, a phrase, or an image. There are hundreds of meditation techniques.
Four main types include focused attention (focusing your attention on one thing for the whole session), open-monitoring (being aware of your thoughts, feelings, and sensations without judgement), loving-kindness (focusing loving energy on yourself and bestowing it on others) and movement-based (exercise that incorporates a calm mind and deep breathing). All of these techniques can be incorporated into one’s daily lifestyle by practicing short sessions throughout the day and extending the practice over time.
You can practice meditation on your own or by using apps or recordings. In the beginning it can be useful to practice with a qualified teacher.
Mindfulness is the practice of focusing attention on what is happening in the present and accepting it without judgment. It is often learned through meditation.
Here’s how to get started with mindfulness meditation.
Sit on a straight-backed chair or cross-legged on the floor. Focus on an aspect of your breathing, such as the sensations of air flowing into your nostrils and out of your mouth, or your belly rising and falling as you inhale and exhale.
Once you’ve narrowed your concentration in this way, begin to widen your focus. Become aware of sounds, sensations, and ideas. Embrace and consider each without judgment.
If your mind starts to race, return your focus to your breathing. Then expand your awareness again.
Progressive muscle relaxation
This form of relaxation therapy focuses on relaxing your muscles in a sequence from the tips of your toes up to your head, or vice versa. You might begin by gently curling up your toes, holding the contraction, and then gently releasing them. Then move on, contracting and releasing the muscles around your ankles, calves, knees, buttocks, hands, and so forth on up to your face and head. You can coordinate progressive muscle relaxation with your breathing — tightening your muscles as you inhale and relaxing them as you exhale.
Qigong (pronounced “chi gong”) is part of ancient Chinese medicine tradition. It combines meditation, gentle exercise, and flowing movements to simultaneously relax the mind and strengthen and stretch the body. In most popular forms of qigong, your breath will be slow, long, and deep; your movements will be gentle and smooth, and you will focus your attention and visualization.
Tai chi is a centuries-old Chinese martial art that descends from qigong. Referred to as “moving meditation,” tai chi combines martial arts with breath control to promote inner peace and calm. Tai chi features slow and graceful movements that flow into one another like a kind of dance.
Tai chi differs markedly from most other types of exercise, which drive you to push harder or go faster. Tai chi is the opposite; instead of tensing your muscles, you want to relax them so your body moves more freely. Instead of isolating certain muscle groups — for example, by doing ab crunches or biceps curls — you want to integrate your entire musculoskeletal system. Instead of picking up the pace, you want to slow down. Tai chi shows you how to get more out of less. “Strong as an oak, flexible as a willow, and [mentally] clear as still water” — that’s what tai chi has to offer, according to classic texts.
Yoga is an integration of mind, body, and spirit with goals of cultivating balance, calm, harmony, and awareness. It combines four components: physical postures, breathing exercises, deep relaxation, and meditation. There are many different types of yoga; some styles put a greater emphasis on one component or another. For example, integral yoga is a gentle and noncompetitive practice that includes chanting, postures, deep relaxation, breathing practices, and meditations. Relaxation is the primary goal of restorative yoga, which uses props such as blankets, blocks, and straps, and may be a good gentle yoga to try.
The Lyme and Tick-Borne Disease Research Center at Columbia University Irving Medical Center conducted a small, preliminary study on the use of kundalini yoga, which incorporates movement, chanting, breathing, and meditating, on people with persistent fatigue and pain after being treated for Lyme disease. The study suggests that kundalini yoga may enhance cognition and may improve the overall symptom burden of Lyme disease, but more research is needed. Kundalini yoga involves deep breathing exercises and slowed breathing, which may cause temporary dizziness or lightheadedness. It should be done with a certified instructor.
You can begin a yoga practice through in-person group classes, online classes, apps, and DVDs. You can find yoga teachers in your area through the International Association of Yoga Therapists.
Important to overall health and well-being.
Healthy eating boils down to three simple rules: eat a varied plant-based diet that limits processed foods; eat fewer animal-based foods; and eat only as much food as your body needs. In practice:
A good diet is rich in minimally processed fruits, vegetables, and whole grains, paired with healthy sources of protein and fats. It emphasizes plant-based foods. Eating a range of fruits and vegetables — especially dark green, red, and orange ones — will provide a broader range of nutrients.
Protein should come primarily from legumes, nuts, fish (choose fish that contain lower levels of mercury), and skinless poultry.
Fats should come from vegetable oils and foods like avocados, nuts, and fatty fish.
Butter, stick margarine, and red meat should be eaten sparingly, and processed or cured meats like ham, hot dogs, and corned beef should be eaten very infrequently.
Cut back on refined carbohydrates (basically, anything made with sugar or refined flour).
Stay well hydrated.
Eating small meals every three to four hours and eating foods that are digested more slowly (brown rice or quinoa rather than white rice, for example) with adequate amounts of good quality protein, healthy fats, and complex carbohydrates may help you sustain energy levels. Anecdotally, some people with COVID-19 find eliminating sugar, gluten, and processed foods to help with fatigue. A nutritionist may offer advice on how to adapt your diet to support your recovery. Talk to your doctor if you experience loss of appetite.
May help with symptoms including: fatigue, sleep disturbances, cognition, and pain.
Good sleep habits (sleep hygiene) can help you get a good night’s sleep. First, set up an ideal sleep environment: Make sure your bedroom is quiet, dark, and cool (around 65 degrees Fahrenheit). In addition, try to:
Go to sleep and wake at the same time each day.
Avoid screens (televisions, computers, iPads) two hours before bedtime.
Avoid caffeine, alcohol, and tobacco.
Limit the liquids you drink after 8 pm to reduce interruptions of your sleep to use the bathroom.
Wind down with some relaxation exercises before bed (see: Mindfulness and relaxation exercises).
If you don’t fall asleep within 20 to 30 minutes of getting into bed, or if you wake up and can’t fall back asleep within that amount of time, get out of bed and do something relaxing until you feel sleepy again.
Cognitive behavioral therapy (CBT) can also be helpful for insomnia. A therapist will help you change unproductive thinking patterns and sleeping habits that get in the way of a good night’s sleep. You can find certified specialists through the Society for Behavioral Sleep Medicine or through the American Board of Sleep Medicine.
Lyme disease and other tick-borne illnesses can severely disrupt normal sleep patterns. Some people with Lyme disease or other tick-borne illnesses suffer from resistant insomnia, or insomnia that persists despite using the above recommendations and over-the-counter or prescription sleep aids. These illnesses, along with other problems that interfere with restful sleep, such as sleep apnea or restless leg syndrome, may need to be addressed in order for you to get a restorative night’s sleep.
Before trying any of these approaches, talk to your doctor to make sure a particular technique will support, rather than hinder, your recovery.
May help with symptoms including: brain fog, fatigue, headaches, nerve-related pain, and temperature regulation.
While the value of acupuncture has only recently been studied by Western medicine, acupuncture is a mainstay of traditional Chinese medicine and has been practiced for thousands of years. The Chinese healing tradition sees the body as a delicate balance of yin and yang. Imbalance, it is believed, blocks the flow of qi, a vital energy that regulates spiritual, emotional, mental, and physical balance. By inserting very thin needles into the skin at specific points on the body along a complex network of lines of energy called meridians, acupuncture is believed to unblock the flow of qi, restoring health to the body and mind.
Some Western scientists believe that acupuncture stimulates the central nervous system and can help with pain, blood pressure, blood flow, and body temperature regulation. Acupuncture should be done by a licensed acupuncturist or by someone certified by the National Commission for Acupuncture and Oriental Medicine (NCAOM) who uses sterilized needles that are disposed of after a single use. You can ask your doctor for recommendations, or check the NCAOM website to find a practitioner in your area.
May help with symptoms including: anxiety, depression, irritability, mood swings, and sleep disturbances.
Aromatherapy is the use of essential oils from plants (flowers, herbs, or trees) as a complementary health approach. Smelling essential oils may calm your body and mind. Essential oils can also be used in massage, added to baths, inhaled in steam through a diffuser, or applied to the body in diluted form. Botanical lemon balm has been shown to reduce anxiety and improve mood, and it may help with sleep, though it is not considered safe in pregnancy. Lavender may help you relax.
May help with symptoms including: memory issues, mood swings, pain, and sleep disturbances.
Biofeedback is a method of training your body to control autonomic functions such as heart rate, muscle tension, breathing, perspiration, body temperature, blood pressure, and brain waves.
During a session, a practitioner places electrodes, which are attached to the biofeedback machine, on specific parts of your body. The machine measures changes in your autonomic functions. It then translates those measurements into feedback that can take the form of a blinking light, a beeping sound, an image of a balloon, or a graph — giving you immediate data on the status of your body. For instance, you might be told first to breathe in a shallow, rapid manner. Then, using the biofeedback machine, you consciously slow your rate of breathing, easing your tension and your pain in the process. To help you do this, the biofeedback machine might show an image of a balloon on the screen representing your breathing rate; you then learn to inflate and deflate the balloon at a slower rate.
Neurofeedback is a type of biofeedback that allows a clinician to view a person’s brain waves while teaching that person to use self-regulation skills. Neurofeedback has been used to help manage chronic pain as well as problems with attention, memory, and mood.
Biofeedback, including neurofeedback, must be administered by a trained professional. Look for someone who has been certified by the Biofeedback Certification Institute of America (BCIA).
May help with symptoms including: brain fog, concentration issues, difficulty with word retrieval, and memory issues.
Cognitive rehabilitation, or cognitive rehab, refers to a group of therapies designed to improve cognitive function (restorative cognitive therapy) or work around a person’s cognitive deficits (compensatory cognitive therapy). Health professionals who provide cognitive rehabilitation therapy include neuropsychologists, neurorehabilitation experts, speech and language therapists, and occupational therapists.
You’ll typically begin with an evaluation to assess your performance on several aspects of cognition: memory, reasoning, attention, language, executive function, and possibly others. The evaluation will pinpoint areas of difficulty and will indicate how severely those areas are affected. The therapist will also want to understand which areas of difficulty are having the most impact on your daily life. For example, problems with memory may have a bigger impact on your day-to-day life even if you score lower on the language portion of the evaluation. Together, you and the clinician will decide which area or areas to prioritize and will set practical treatment goals intended to improve daily function.
Cognitive rehabilitation therapy looks different from person to person. For example, a person working to restore executive functioning may practice breaking down larger tasks into achievable components, while someone working to restore memory may practice creating associations or grouping related items in their minds. Regardless of the skill being worked on, cognitive rehab relies on structured, repetitive practice for success. You’ll also practice using compensatory strategies, such as daily planners, alarms, and electronic organizers, to help perform important activities of daily living.
May help with symptoms including: anxiety, fatigue, pain, and sleep disturbances.
Dietary supplements contain one or more dietary ingredients, including vitamins, minerals, herbs or other botanicals, amino acids, enzymes, tissues from organs or glands, or extracts of these.
Dietary supplements are not reviewed for safety and efficacy by the FDA and should be taken with caution. The FDA also does not monitor the manufacture of supplements: what’s listed on the label of a dietary supplement may not be what’s actually in the product. In addition, the amount of scientific evidence on dietary supplements varies widely — there is a lot of information on some and very little on others. Information on some supplements is available at NIH’s National Center for Complementary and Integrative Health website. Always talk with your doctor before starting any supplement, as they can have side effects, and can interact with other medications you might be taking.
If you do use supplements, it’s important to select high-quality sources that bear the U.S. Pharmacopeia Dietary Supplement Verification Program (USP-DSVP) mark or the FDA’s Good Manufacturing Practices (GMP) label, which indicate that the supplement manufacturer has complied with certain standards. You can get many of the nutrients found in supplements by eating a healthy and varied diet (see: Nutrition).
May help with symptoms including: anxiety, body aches, brain fog, concentration issues, depression, headache, neck stiffness, joint pain, muscle pain, nerve-related pain, and sleep disturbances.
Manual therapies are hands-on therapies such as chiropractic treatment, reflexology, therapeutic massage, craniosacral therapy, and myofascial release. Certain manual therapies should be done with caution and only by someone who is well trained. You should consult with your physician to determine if a treatment is appropriate and for you. Your doctor may be able to help you find qualified practitioners for manual therapies.
Chiropractic spinal manipulation involves quick but strong pressure on a joint between two vertebrae of the spine, to correct the body’s alignment. Though chiropractic has been little studied in people with Lyme disease, some people report that it has helped to reduce pain and improve function. Chiropractic treatment should be done with caution and with a licensed chiropractor.
Therapeutic massage may help relieve several types of pain, and help relieve stress, anxiety, and depression in some people. However, some people with ME/CFS have reported worsening of symptoms after massage. It may be best to begin by observing how your body responds to light-to-medium pressure massage. Craniosacral therapy and myofascial release are two techniques sometimes used in massage therapy. Myofascial tissues are membranes that wrap around the muscles. Myofascial release uses light touch to loosen the fascia, which may help to relieve pain. Craniosacral therapy uses light touch to manipulate membranes and the movement of fluids in and around the central nervous system to relieve pain. The American Massage Therapy Association provides a free locator for licensed massage therapists.
While these techniques won’t eliminate symptoms, they can help a person compensate for the effects of: brain fog, concentration issues, disorientation, fatigue, lethargy, memory issues, pain, sensitivity to light, sensitivity to sound, and trouble finding words.
An occupational therapist can provide recommendations for modifying activities and adapting the environment to help you more easily perform day-to-day tasks and activities at home, work, school, or in the community that may have been impacted by Lyme disease. For example, if you are experiencing fatigue, an OT might recommend strategies for conserving your energy. If you are unable to tolerate certain environments, an OT can help you to reduce multisensory stimulation. An OT can also recommend modifications to your work environment. Your doctor can refer you to an occupational therapist.
While these techniques won’t relieve symptoms, they can help compensate for the effects of cognitive symptoms resulting from Lyme disease including: brain fog, concentration issues, disorientation, and memory issues.
Established techniques for people recovering from brain injury can also help people experiencing cognitive symptoms of Lyme disease. Strategies include:
taking notes using a paper planner
using an app to record your schedule
setting electronic reminders
writing out a list of things you need to do each day
focusing on doing one task at a time
scheduling breaks into your day
minimizing background distractions
using a medication organizer and setting alarms to remind you to take them.
May help with symptoms including: brain fog, concentration issues, fatigue, and sleep disturbances.
If you notice that your symptoms flare or you “crash” after physical or mental exertion, you might benefit from pacing. Pacing is a strategy of planning when and how to use your limited energy so as not to overexert yourself and worsen symptoms.
Some suggestions for pacing:
Prioritize tasks and spread them out over the day or week. For example, go grocery shopping in the morning, take a rest, and then run another errand in the afternoon if you can.
Take advantage of times when your energy is good, and don’t push your body when you are fatigued. (Be sure not to overdo it when you’re feeling good to avoid “crashing” after your activity.)
At work, try dividing up a longer task, like writing an article, into smaller chunks (say, a paragraph at a time), and take breaks in between.
Give yourself more time to complete tasks.
Ask for and accept help with tasks when you can.
Outsource when possible: Are there ways to get help cleaning your home? Can a neighborhood teen tend to your yardwork?
See if you can modify your work or school schedule to avoid long stretches of mental or physical exertion.
Avoid or moderate activities that it takes you longer to recover from.
Medical problems such as low blood sugar, blood sugar swings, low blood pressure, and postural orthostatic tachycardia syndrome (POTS) can contribute to “crashes.” Your doctor can evaluate you for these conditions if you experience fatigue, dizziness or lightheadedness upon standing, palpitations, or fainting.
May help with symptoms including: anxiety, depression, and pain.
The aim of psychotherapy is to relieve mental, emotional, and behavioral symptoms by encouraging more constructive ways of thinking and acting. Therapy can help you better deal with problems and live a more healthy and satisfying life. Talk therapy can be particularly helpful if you are struggling to adjust to new limitations caused by your Lyme disease symptoms or if you are experiencing anxiety or depression.
There are different types of psychotherapy:
cognitive behavioral therapy teaches people to change negative thought patterns and behaviors than can exacerbate pain and other Lyme disease symptoms
interpersonal therapy concentrates on resolving interpersonal problems at work and at home
psychodynamic therapy focuses on how life events, desires, and past and current relationships affect your feelings and the choices you make.
Many therapists combine elements of these three techniques. It’s important that you are comfortable with your therapist’s style and the techniques they employ. You can ask your doctor to recommend a therapist. Some therapists offer online, or telehealth, appointments in addition to in-person appointments.
May help with symptoms including: brain fog and physical fatigue.
Even if you get enough sleep at night, you may also need to rest during the day. Rest should go hand in hand with pacing (see Pacing). You may benefit from mental rest, physical rest, or both. A mental break might involve stepping away from your screen during the workday to sit outside enjoying a warm breeze and listening to the birds. A physical break might mean relaxing in a recliner. Schedule a nap into your day if that is helpful (and possible). Listen to your body and allow yourself to rest when needed.
Sensory quiet time
May help with symptoms including: sensitivity to light, sensitivity to sound.
If you find that environmental stimuli like light or sound are uncomfortable or overwhelming, it may help to take planned breaks from screens or noisy environments. For example, take short breaks throughout the day to rest in a quiet place with an eye mask and noise-canceling headphones or earplugs. Try turning off sound notifications on your phone or your work computer. If you enjoy movies but can’t tolerate the loud volume, look for sensory-friendly showings. If the overhead fluorescent lighting is too bright at the office, request a desk or floor lamp.
May help with symptoms including: anxiety, depression, irritability, and mood swings.
Illness can be isolating, and loneliness can have serious health consequences. A strong social support network can be grounding when you’re in distress. Simply connecting with others can lower stress hormones and decrease perceived stress.
When you’re unwell, it’s particularly helpful to have the support and care of people around you. Create a network of people who understand what you’re going through. This can be friends, family members, or people in your religious community. Patient support groups are another place to find people who share a common experience.
Not everyone will fully understand what you’re going through; you may need to decide to limit the time you spend with people who are unsupportive. On the other hand, if someone offers their help, tell them what you need, whether it’s getting groceries, accompanying you to a doctor’s appointment, or simply giving you a hug.
The following medications do not treat Lyme disease itself but may be used to manage symptoms. Some of these medications are available over the counter (OTC), while others require a doctor’s prescription. None have been FDA-approved specifically to treat Lyme disease symptoms, but doctors may prescribe them off-label — that is, to treat conditions outside FDA-approved use.
All medications can cause side effects or interact with other medications and supplements you take. Be sure to tell your doctor about all the medications you take, both OTC and prescription.
Over-the-counter (OTC) medications
The following medications are available without a doctor’s prescription.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
May help with symptoms including: pain, such as headaches, joint pain, and Lyme arthritis.
These drugs reduce pain and swelling by blocking production of chemicals involved in the body’s inflammatory response. Over the counter NSAIDs include ibuprofen (Advil, Motrin) and naproxen (Aleve). NSAIDs may increase risk of bleeding in the stomach or intestines. Long-term use may increase the risk of heart attack or stroke, especially in people with heart disease. Ask your doctor if NSAIDs are safe for you.
May help with symptoms including: sleep disturbances.
OTC sleeping pills usually contain an antihistamine that causes sleepiness. The antihistamines found in these products are generally safe when taken as directed for short periods of time. But they can cause nausea and, rarely, fast or irregular heartbeat, blurred vision, or heightened sensitivity to sunlight. Complications are generally more common in children and in people over age 60. Sleep experts generally advise against using these medications for more than brief periods, because they are often ineffective and because of the possibility of side effects. It is therefore important to ensure overlapping causes of insomnia, including lifestyle factors, medications, and other underlying medical conditions, have been addressed before using OTC sleeping pills.
Melatonin is a hormone, produced in the brain at night, that plays a role in regulating sleep and circadian rhythms. Since the 1990s, a synthetic version has been widely available in the United States as a supplement at health food stores and pharmacies. Despite some initial enthusiasm for synthetic melatonin, a review by the federal Agency for Healthcare Research and Quality (AHRQ) concluded that the supplement “is not effective in treating most sleep disorders.” Melatonin does not appear to pose any major health risks when taken for a short time. It’s best taken in the early to mid evening, about two hours before bedtime. The most commonly reported side effects are nausea, headache, and dizziness. Its long-term effects are unknown. As with other dietary supplements, the amount of active ingredient may vary widely. Surprisingly, smaller doses appear to work better than larger ones. If you take melatonin, do not take more than 3 mg without checking with your doctor.
The following medications require a doctor’s prescription.
May help with symptoms including: burning sensations, headache, irritability, mood swings, numbness, pain, sensitivity to light, sensitivity to sound, stabbing sensations, and tingling sensations.
Anticonvulsants are FDA-approved to treat seizure disorders, as well as other medical conditions unrelated to seizure disorders. Certain anticonvulsant medications such as pregabalin (Lyrica) and gabapentin (Neurontin) may be used to help relieve neuropathic pain, such as burning or stabbing sensations, in people with Lyme disease. The anticonvulsants gabapentin, valproate (Depakote), and carbamazepine (Tegretol) can also help stabilize mood, and may help control chronic pain, migraine headaches, and sensory sensitivities including sensitivity to sound and skin sensory hypersensitivity. Gabapentin is sometimes used in people with other medical conditions to help with sleep.
Side effects of these drugs may include dizziness, drowsiness, loss of balance, problems with memory or concentration, depression, tremors, and blurred or double vision.
May help with symptoms including: anxiety, concentration issues, depression, fatigue, irritability, mood swings, pain (including nerve-related, muscular, and arthritis-related pain).
There are several different types of antidepressants, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), norepinephrine and dopamine reuptake inhibitors (NDRIs), and tricyclic antidepressants (TCAs). Each of these drugs can be used to treat depression, including depression brought on by Lyme disease.
Antidepressants can also be used to help with pain, energy, cognitive focus, and sleep, though they may need to be prescribed at different doses than those used for depression. Studies on people with fibromyalgia show that SSRIs and SNRIs can help reduce pain signals. TCAs are sometimes used to treat neuropathic pain. NDRIs like bupropion (Wellbutrin) may reduce pain, and may also help with energy and cognitive focus. In people with other conditions, low-dose TCAs have helped with sleep.
It can take several weeks for antidepressants to begin working to improve depression, although their effects may be more immediate in treating other symptoms. Each antidepressant has its own set of potential side effects, so ask your doctor what to look out for and let your doctor know if you experience any of them; they may be able to switch you to a different drug or drug class or adjust the dose. Though rare, antidepressants may cause suicidal thoughts or behaviors, particularly in the first weeks of treatment. Seek immediate medical help if you are experiencing suicidal thoughts.
Disease-modifying anti-rheumatic drugs
May help with symptoms including: Lyme arthritis.
Disease-modifying anti-rheumatic drugs (DMARDs) alter the function of the immune system. They are commonly used in people with rheumatoid arthritis (RA) to reduce or prevent joint damage and preserve joint function. There are a number of DMARDs. The DMARDs hydroxychloroquine (Plaquenil) and methotrexate (Reditrex, Trexall, Xatmep) can be used to relieve joint inflammation in people with persistent Lyme arthritis.
It can take many weeks for these drugs to take effect. Common side effects of methotrexate are upset stomach and mouth sores. Hydroxychloroquine can cause visual problems; regular eye examinations can spot early changes that could mean you should stop taking it. Hydroxychloroquine can also disrupt heart rhythm. More serious side effects of DMARDs, including damage to the gastrointestinal tract, lungs, liver, kidneys, and bone marrow, are also possible. Talk to your doctor in detail about possible risks and benefits of these drugs.
Intravenous Immunoglobulin (IVIG)
May help with symptoms including: burning sensations, numbness, stabbing sensations, and tingling sensations.
Immunoglobulins are proteins in blood plasma that help your body fight infections. Intravenous immunoglobulin (IVIG) delivers treatment intravenously (directly into the bloodstream). IVIG treatment tamps down the body’s inflammatory response by decreasing the amount of inflammatory molecules circulating in the body.
IVIG has been shown to be effective in reducing nerve-related symptoms like tingling or burning sensations in people with autoimmune disease. The role of intravenous immunoglobulins for the treatment of Lyme symptoms is still being evaluated. Most people do not have side effects with IVIG, but some experience headache, chills, fever, flushing, flulike muscle or joint pains, fatigue, nausea, vomiting, and rash.
Low-dose naltrexone (LDN)
May help with symptoms including: irritability, mood swings, and pain.
Naltrexone has traditionally been used to treat opioid addiction by blocking the “high” that these drugs can give you. In much smaller doses, low-dose naltrexone (LDN) has been used in people with ME/CFS and long-haul COVID-19 to help reduce pain. There is limited evidence for this use.
LDN is generally well tolerated but may cause vivid dreams, headache, or insomnia. If it causes sleep disturbance, your doctor may suggest taking it in the early morning.
Medical marijuana and CBD
May help with symptoms including: anxiety, depression, irritability, mood, pain, and sleep disorders.
The medical use of cannabis (marijuana) dates back at least several thousand years in China, India, and the Middle East. The active compounds of medical cannabis include chemicals called cannabinoids. The most familiar is delta-9-tetrahydrocannabinol (THC), which produces a “high,” relaxation, or euphoria. Another cannabinoid, cannabidiol (CBD), is not intoxicating, but has been touted for treatment of various conditions.
Despite this, moderate to conclusive evidence for the effectiveness of medical marijuana has only been found for a limited number of conditions. A 2017 report by a committee of the National Academies of Sciences, Engineering, and Medicine found conclusive evidence that medical marijuana (which contains both THC and CBD) is effective for chronic pain. It also found moderate evidence of effectiveness for disturbed sleep associated with sleep apnea, fibromyalgia, chronic pain, or multiple sclerosis.
Used alone, CBD extract may make you feel mellow, experience less pain, and be more comfortable without experiencing an intoxicating “high.” If you choose to use CBD products, pick ones that have been appropriately tested to avoid unintentional intoxication. It’s best to purchase CBD products through a dispensary, which is legally licensed to sell marijuana, if they are available in your state.
State-level medical marijuana laws vary, but they all require a qualifying condition. The National Conference of State Legislatures website maintains a list of cannabis laws by state. If medical marijuana is available in your state, a health care provider can certify you to legally obtain and use medical cannabis. You’ll then need to register with your state as a certified medical cannabis user. Only certain establishments are allowed sell marijuana, and these vary by state.
May help with symptoms including: joint pain, Lyme arthritis.
Prescription doses of nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce joint pain and swelling by blocking production of chemicals involved in the body’s inflammatory response. NSAIDs available in prescription-strength doses include naproxen (Naprosyn), ibuprofen (Motrin), and indomethacin (Indocin).
NSAIDs may carry an increased risk of bleeding in the stomach or intestines. Long-term use may increase the risk of heart attack or stroke, especially in people with heart disease. Ask your doctor if NSAIDs are safe for you.
May help with symptoms including: sleep disturbances.
Prescription sleep medications can help with difficulty falling or staying asleep. Several different drug classes may be prescribed. These include:
Benzodiazepines, which enhance the activity of GABA, a neurotransmitter that calms brain activity
Nonbenzodiazepines, which act specifically on sleep receptors in the brain to enhance the sleep-inducing activity of GABA
Low-dose antidepressants. How they work isn’t clear, but they appear to increase the amount of deep, restorative sleep each night, as reflected in brainwave patterns. In addition, the drugs’ ability to ease anxiety and mild depression may make it easier for people with these problems to relax and fall asleep.
Melatonin-receptor agonists, which mimic the body’s naturally produced melatonin, a hormone that promotes sleep.
Sleep medications should be used at the lowest effective dose for the shortest possible period of time. As with all drugs, sleep medications have side effects. For example, many people who use benzodiazepines develop tolerance — the need to take more and more of the drug in order to obtain the same effect. For this reason, there is a high risk for developing an addiction to this type of medication. After a few weeks, the drugs may no longer promote sleep. With any sleep medication, allow for a full eight hours of sleep, and avoid doing things that demand high levels of alertness first thing in the morning.
May help with symptoms including: brain fog, concentration issues, fatigue, and sleep disorders.
Stimulant medications help raise the levels of certain chemical substances in the brain that affect attention, mood, movement, and motivation.
Some people with Lyme disease benefit from a short course of stimulant medication to help with focus, such as dextroamphetamine (Dexedrine) or methylphenidate (Ritalin, others). While these medications can be very helpful in the short term, some people become dependent on them. Work closely with your doctor to find the right dose and duration of treatment. Long acting stimulants like lisdexamfetamine (Vyvanse) can also interfere with sleep; speak to your healthcare provider about any sleep difficulties.
Stimulants that promote wakefulness, such as modafinil (Provigil) and armodafinil (Nuvigil), have been shown to help with fatigue in people with other diseases. In people with long-haul COVID-19, these stimulants are used to help with fatigue and sleep.
1. A Guide to Healthy Eating. Harvard Health Publishing, 2019.
2. Acupuncture for Fibromyalgia: An Open-Label Pragmatic Study on Effects on Disease Severity, Neuropathic Pain Features, and Pain Catastrophizing. Evidence-based Complementary and Alternative Medicine: eCAM, 2020.
3. Aromatherapy. NIH website, January 2020.
4. Behavioral Health Recommendations for Managing Long-COVID Symptoms. Critical Illness and COVID-19 Survivorship Program, Beth Israel Lahey Health, 2021.
5. Conquering Lyme Disease: Science Bridges the Great Divide. Columbia University Press, 2018.
6. Diagnosis and treatment of Lyme arthritis. Infectious Disease Clinics of North America, 2015.
7. Dietary and herbal supplements. NIH website, February 2020.
8. Efficacy and Tolerability of Gabapentin in Adults with Sleep Disturbance in Medical Illness: A Systematic Review and Meta-analysis. Frontiers in Neurology, 2017.
9. Encyclopedia of the Neurological Sciences. Academic Press, 2003.
10. Improving Sleep. Harvard Health Publishing, 2019.
11. Influence of craniosacral therapy on anxiety, depression, and quality of life in patients with fibromyalgia. Evidence-based Complementary and Alternative Medicine: eCAM,2011.
12. Introduction to Yoga. Harvard Health Publishing, 2020.
13. Kundalini Yoga for Post-Treatment Lyme Disease: A Preliminary Randomized Study. Healthcare, 2022.
14. Massage therapy for health. NIH website, 2018.
15. Meditation for Your Health. Harvard Health Publishing, 2021.
16. Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of fatigue in postacute sequelae of SARS-CoV-2 infection (PASC) patients. PM & R: The Journal of Injury, Function, and Rehabilitation, 2021.
17. Musculoskeletal manifestations of Lyme disease. UpToDate, November 2022.
18. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Essentials of Diagnosis and Management. Mayo Clinic Proceedings, 2021.
19. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Treating the Most Disruptive Symptoms First and Preventing Worsening of Symptoms. CDC website, April 2021.
20. Pain Relief Without Drugs or Surgery. Harvard Health Publishing, 2019.
21. Patient education: Disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (Beyond the Basics). UpToDate, November 2022.
22. Patient education: Intravenous immune globulin (IVIG) (Beyond the Basics). UpToDate, November 2022.
23. Pharmacologic management of chronic non-cancer pain in adults. UpToDate, November 2022.
24. Qigong: What you need to know. NIH website, February 2022.
25. The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain. Clinical Rheumatology, 2014.
26. Treatment options. Columbia University Irving Medical Center, Lyme and Tick-Borne Diseases Research Center website.
27. Understanding Depression. Harvard Health Publishing, 2020.
28. What constitutes appropriate treatment of post-Lyme disease symptoms and other pain and fatigue syndromes? Clinical Infectious Diseases, 2015.