Anxiety
Disorders
In some people, symptoms associated with anxiety disorders, like irrational fears, irritability and excessive worrying, may be caused by an infection-triggered autoimmune encephalopathy, rather than a psychiatric illness.

When your medication is not working for anxiety

Anxiety disorders as a group are the most prevalent psychiatric conditions in the United States. 1 They can have a serious impact on a person’s quality of life. In fact, too many patients say their medication is not working well enough to alleviate or manage their symptoms.

An estimated 40% of patients with an anxiety disorder do not respond to first-line treatment (i.e., antidepressants, benzodiazepines, and cognitive-behavioral therapy.) Up to 30% are considered treatment resistant patients. 1

Untreated anxiety is a very real concern. Aside from its ability to cause debilitating mental anguish and the increased risk of suicide 1, anxiety that is not treated can lead to major depressive disorder. 2

Treatment resistant anxiety

There may be several reasons why an anxiety medication is not working. A patient may have co-morbid conditions or they may not be taking the medication as prescribed. Or, anxiety symptoms may be due to an underlying and untreated biological cause, such as a bacterial or viral infection.

“Some infections start as a peripheral infection in the body and can cross the blood-brain barrier and come into the brain, and thereby cause damage and increase the risk of mental disorders.” 3

For example, common childhood infections, such as strep, mycoplasma pneumoniae, Epstein Barr virus, influenza, sinusitis, herpes viruses and Lyme disease are known to trigger pediatric autoimmune neuropsychiatric syndromes which can manifest with severe anxiety, separation anxiety, and irrational fears.

These patients may be misdiagnosed with an anxiety disorder, when they could have an autoimmune condition. How does this happen? Common infections, often hidden or without obvious symptoms, can trigger the immune system to produce antibodies to kill and remove the invading germs, and in some patients, the antibodies they make may cross react with certain parts of their brain.

Immune system in overdrive

In certain types of autoimmune conditions the immune system kicks into overdrive and mistakenly attacks healthy cells in the region of the brain that controls movements and emotions, as well as other body functions. This attack may also cause brain inflammation and the onset of psychiatric symptoms and behavioral changes.

These patients often report that their medication is not working or that it is making symptoms worse.

Be sure to consult your doctor because individuals with an infection-triggered autoimmune encephalopathy often require treatment with immune-modulating therapy in addition to antimicrobial and anti-inflammatory medications, rather than just psychiatric medications. When treated properly, patients often report complete or substantial reduction in symptoms.

  1. Bystritsky, A. Treatment-resistant anxiety disorders. Molecular Psychiatry, volume 11, pages805–814 (2006) https://www.nature.com/articles/4001852
  2. Meier SM, Petersen L, Mattheisen M, Mors O, Mortensen PB, Laursen TM. Secondary depression in severe anxiety disorders: a population-based cohort study in Denmark. Lancet Psychiatry. 2015;2(6):515–523. doi:10.1016/S2215-0366(15)00092-9 https://www.ncbi.nlm.nih.gov/pubmed/26360447/
  3. Roy-Byrne P. Treatment-refractory anxiety; definition, risk factors, and treatment challenges. Dialogues Clin Neurosci. 2015;17(2):191-206. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518702/
  4. Witthauer C, Gloster AT, Meyer AH, Goodwin RD, Lieb R. Comorbidity of infectious diseases and anxiety disorders in adults and its association with quality of life: a community study. Front Public Health. 2014;2:80. Published 2014 Jul 14. doi:10.3389/fpubh.2014.00080 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4095564/
  5. Infections may raise the risk of mental illness in children. NPR. Health Shots. 2018. https://www.npr.org/sections/health-shots/2018/12/05/673700889/infections-may-raise-the-risk-of-mental-illness-in-children
  6. Köhler-Forsberg O, Petersen L, Gasse C, et al. A Nationwide Study in Denmark of the Association Between Treated Infections and the Subsequent Risk of Treated Mental Disorders in Children and Adolescents. JAMA Psychiatry. 2019;76(3):271–279. doi:10.1001/jamapsychiatry.2018.3428 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2716981
  7. Jennifer Frankovich, Susan Swedo, Tanya Murphy, Russell C. Dale, Dritan Agalliu, Kyle Williams, Michael Daines, Mady Hornig, Harry Chugani, Terence Sanger, Eyal Muscal, Mark Pasternack, Michael Cooperstock, Hayley Gans, Yujuan Zhang, Madeleine Cunningham, Gail Bernstein, Reuven Bromberg, Theresa Willett, Kayla Brown, Bahare Farhadian, Kiki Chang, Daniel Geller, Joseph Hernandez, Janell Sherr, Richard Shaw, Elizabeth Latimer, James Leckman, Margo Thienemann, and PANS/PANDAS Consortium. Journal of Child and Adolescent Psychopharmacology. Sep 2017.574-593.http://doi.org/10.1089/cap.2016.0148 https://www.liebertpub.com/doi/full/10.1089/cap.2016.0148
When your medication is not working for anxiety

An estimated 40% of patients with an anxiety disorder do not respond to first-line treatment.

Infections may cause anxiety that won’t go away and medication may not be working for anxiety
Find Out: How can an infection cause symptoms of anxiety?

Learn more about how infections can trigger neuropsychiatric symptoms

Cunningham Panel helps identify an autoimmune disorder in child initially diagnosed with schizophrenia

Cunningham Panel™ helps identify an autoimmune disorder in child initially diagnosed with schizophrenia

Researchers describe a complex case involving a 15-year-old girl, who abruptly developed multiple neurologic and psychiatric symptoms.

Autoimmune diseases and severe infections as risk factors for mood disorders: a nationwide study

Autoimmune diseases and severe infections as risk factors for mood disorders: a nationwide study

This nationwide, population-based, prospective cohort study examines the link between mood disorders, infections, and autoimmune disease.

Childhood infections can increase risk of mental illness in kids

Childhood infections can increase risk of mental illness in kids

Nationwide study finds both mild and severe infections can increase risk of mental disorders in children and adolescents.

  • Test Order Process
    The Cunningham Panel™ – Antibody testing that helps determine whether an autoimmune response may be triggering neurologic and/or psychiatric symptoms. 

B. Robert Mozayeni, MD

Medical and Clinical Advisor

B. Robert Mozayeni MD

Dr. B. Robert Mozayeni was trained in Internal Medicine and Rheumatology at Yale and at NIH. He has had pre- and post-doctoral Fellowships in Molecular Biophysics and Biochemistry at Yale, and also at NIH where he was a Howard Hughes Research Scholar at LMB/DCBD/NCI and later, Senior Staff Fellow at LMMB/NHLBI/NIH. Editorial board of Infectious Diseases – Surveillance, Prevention and Treatment. Past President of the International Lyme and Associated Diseases Society (ILADS).

He is an expert in Translational Medicine, the science and art of advancing medical science safely and efficiently. He is a Fellow of the non-profit Think Lead Innovate Foundation and is a co-founder of the Foundation for the Study of Inflammatory Diseases. He is a Founder of the Foundation for the Study of Inflammatory Diseases to crowd-source medical solutions for complex conditions using existing knowledge, diagnostic methods, and therapies to meet patient needs immediately. He is the Chief Medical Officer of Galaxy Diagnostics, LLC. He is a Board member of the Human-Kind Alliance. Dr. Mozayeni has held admitting privileges (since 1994) on the clinical staff of Suburban Hospital, a member of Johns Hopkins Medicine and an affiliate of the National Institutes of Health Clinical Center.

Safedin Sajo Beqaj, PhD, HCLD, CC (ABB)

Moleculera Labs, Clinical Laboratory Advisor
Medical Database, Inc., President and CEO

Sajo Baqaj, PhD

Dr. Sajo Beqaj is board certified in molecular pathology and genetics and licensed as a Bioanalyst and High Complexity Laboratory Director. He has been practicing as a laboratory director since 2005.

Dr. Beqaj served as a technical director and was part of the initial management team for several well-known laboratories in the clinical lab industry including PathGroup, Nashville, TN; DCL Medical Laboratories, Indianapolis, IN, and Pathology, Inc, Torrance, CA. He is currently serving as off-side CLIA laboratory director for BioCorp Clinical Laboratory, Whittier, CA and Health360 Labs, Garden Grove, CA.

Dr. Beqaj received his Ph.D. in Pathology from Wayne State University Medical School, Detroit, Michigan. He performed his post-doctoral fellowship at Abbott Laboratories from 2001-2003 and with Children’s Hospital and Northwestern University from 2003-2005.

Dr. Beqaj has taught in several academic institutions and has published numerous medical textbook chapters and journal articles. He has served as a principal investigator in clinical trials for several well-known pharmaceutical and diagnostic companies such as Roche HPV Athena, Merck HPV vaccine, BD vaginitis panel, Roche (Vantana) CINtec® Histology clinical trials, and has presented various scientific clinical abstracts and presentations.

He is a member of several medical and scientific associations including the Association of Molecular Pathology, American Association of Clinical Chemistry and the Pan Am Society for Clinical Virology. He has served on a number of clinical laboratory regulatory and scientific committees, and has assisted several laboratories and physicians as a Clinical Laboratory Consultant.