As with neuropsychological outcomes in PTLD, neuropsychiatric presentations are not universal but occur in a subgroup of patients (Rebman et al., 2021). e pri­mary evidence for psychiatric diculties in PTLD is mood related, but there is no evi­dence showing high rates of pre- illness psychiatric comorbidities in this group. PTLD groups generally have higher reporting of depressive symptoms compared to healthy controls but lower ratings compared to patients diagnosed with depressive disorders, and ratings oen do not meet criteria for diagnosis of clinical depression when com­pared to population norms (Keilp et al., 2019; Westervelt & McCarey, 2002). Recent large- scale epidemiological studies do show increased risk of mood disturbance in the year following the initial diagnosis of Lyme disease (Fallon et al., 2021; Rebman et al., 2021; Tetens et al., 2021) but thus far, existing studies have not demonstrated that depression and/ or mood disturbances are caused by neuropsychiatric sequelae of Lyme disease. Mood diculties in a subgroup of PTLD patients may be attributable to increased psychological burden of dealing with disruptive symptoms, increased physical and social limitations, sense of loss of control, symptom invisibility, illness legitimacy, and perceived medical uncertainty (Rebman et al., 2015).