Teenager develops psychosis after abuse with antibiotics and disulfiram

Disulfiram is a dangerous drug that has been irresponsibly hyped by the harmful chronic Lyme movement. There is no reason to take it for any infection-caused illness, including Lyme disease and Babesiosis, but it can cause reactions from toxicity.

Disulfiram blocks the body’s ability to detox alcohol, causing illness and potentially hospitalization if someone ingests alcohol while on the drug.

Marketed as Antabuse, Disulfiram can be used in the treatment of alcoholism, where some patients find it beneficial. However, some doctors will not recommend it for alcoholism because they don’t think the benefits outweigh the risks.

Uncommon but known side effects of Disulfiram include peripheral neuropathy, psychosis, and potentially-fatal liver-injury.

There has even been a report of a “chronic Lyme” patient dying from disulfiram toxicity.

Sadly, the Medical Child Abuse that is facilitated by “Lyme literate” grifters and chronic Lyme “support” groups also includes disulfiram.

According to a review published by the American Academy of Pediatrics:

The long-term prognosis for individuals who are treated appropriately with antimicrobials for Lyme disease, regardless of the stage of the illness, is excellent. The most common reason for a lack of response to appropriate antimicrobial therapy is misdiagnosis (ie, the patient actually does not have Lyme disease).

Nonspecific symptoms, such as fatigue, arthralgia, or myalgia, may persist for several weeks even in patients with early Lyme disease who are treated successfully. Their presence should not be regarded as an indication for additional treatment with antimicrobials. These nonspecific symptoms will usually resolve without additional antimicrobial therapy.

There is substantial evidence that there is no such entity as chronic Lyme disease. Indeed, there is not even a case definition for chronic Lyme disease. There are many websites that contain misinformation about Lyme disease that only enhance the already inflated and inaccurate fears about the consequences of Lyme disease of many parents and patients.

Many patients labeled as having chronic Lyme disease actually have medically unexplained symptoms. Such patients are best treated symptomatically rather than with prolonged courses of antimicrobial therapy, which have been associated with serious adverse effects and little or no benefit. It is important to acknowledge that the patient has symptoms even if they are not due to Lyme disease. 

The above quoted 2014 review recommends 14-28 days of first-line antibiotics for Lyme disease. In 2020, consensus guidelines endorsed by the American Academy of Pediatrics and many other North American medical groups found that shorter antibiotics courses were effective in some manifestations. Therefore, the recommendation became 10-28 days of first-line antibiotics.

Below is a copy of an abstract presented at the 2021 annual meeting of the American Psychiatric Association, which is also available in PDF format.

The provision of a pseudoscientific “chronic Lyme” diagnosis and appalling prescriptions of disulfiram and a year of antibiotics are clear signs of Medical Child Abuse.

Disulfiram-Induced Psychosis in an Adolescent Treated for Chronic Lyme Disease: A Case Report and Review of Related Literature

Poster Presenter: Christina Michael, B.S.

Co-Authors: Kenny Hirschi, M.D., Ramnarine Boodoo, M.D., Daisy Shirk, M.D., Jasmin G. Lagman, M.D.


Introduction: Disulfiram (DSF) is a commonly prescribed medication for the treatment of alcohol use disorder. DSF has been recently studied in the treatment of Lyme Disease but with minimal data and contrasting results. Treatment has shown significant psychiatric side effects and has even resulted, in the adult population, in acute psychiatric hospitalization during treatment. We present a case of a 16 y/o male that was hospitalized status post treatment of Chronic Lyme disease with DSF that developed fulminant psychosis. 

Objectives: To discuss the presentation of overt psychosis in an adolescent on disulfiram for chronic Lyme disease. 

Case Presentation: A 16-year-old male with a history of chronic Lyme disease presents to the emergency department (ED) for altered mental status (AMS). Patient was found running naked in the woods when the police were called. 

At the ED the patient stated he was “running from God” and reported auditory hallucinations. Past history includes an inpatient stay last year when he had presented to the hospital with AMS. His behavior at the time was described as having inappropriate laughter, grandiose ideas, delusions and pressured speech. 

He was given antibiotics and presented back to the hospital when his symptoms did not improve. Workup at that time yielded a diagnosis of Lyme disease. Lyme IgG was positive. Head CT showed no abnormalities.

He was on antibiotics for a year where he was reported to be “stable”, then followed up with a Lyme disease specialist who recommended switching treatment to DSF. He was taken off of DSF after three weeks of treatment, a few days prior to presentation – at which he presented with overt psychosis. During his inpatient stay, he was sexually and religiously preoccupied, disorganized and exhibited aggressive behavior. He responded minimally with Olanzapine and responded better with the addition of valproate.

Discussion: Disulfiram is an irreversible aldehyde dehydrogenase inhibitor and in the context of alcohol use results in increased serum levels of acetaldehyde, which can precipitate symptoms of diaphoresis, palpitations, facial flushing, nausea, vertigo, hypotension, and tachycardia with the goal of discouraging further alcohol use. This is referred to as a DSF reaction and, due to the variability in half-life of this medication, has been seen in patients up to 2 weeks after discontinuation of therapy. 

There are also commonly associated dermatologic, psychiatric, and cardiac side effects. A lesser known mechanism of action of DSF is that it also inhibits dopamine betahydroxylase (via metabolite of DSF; Diethyldithiocarbamate) which is an enzyme that converts dopamine (DA) to norepinephrine (NE). This lesser known mechanism of DSF results in an increase in DA within the brain and is the principle mechanism implicated in psychosis seen with DSF dosing. To our knowledge, there have been no studies regarding adolescents presenting with psychosis secondary to disulfiram.

Related resources

Literature review: Prat S, et al. Diagnosis and treatment of “chronic Lyme”: primum non nocere. BMC Infectious Diseases. 2023.

Shapiro ED. Borrelia burgdorferi (Lyme disease). Pediatr Rev. 2014.

Vos B, et al. Adverse events associated with pediatric complementary and alternative medicine in the Netherlands: a national surveillance study. Eur J Pediatr. 2021. (shareable link)

Metro: Woman underwent years of treatment for Lyme disease and needed a wheelchair – but her life was a lie

Bloomberg Businessweek: Dubious Alternative Lyme Treatments Are Killing Patients (How a teenager died while under the care of long-time charlatan Marvin Rick Sponaugle)

Listernick, RH. A 17-year-old Boy Previously Diagnosed With Chronic Lyme Disease. 2004.

Reports of harm from treatment for “chronic Lyme disease”, where the patient was also receiving disulfiram:

(The above abstract) Michael, Christina, et al. Disulfiram-Induced Psychosis in an Adolescent Treated for Chronic Lyme Disease- A Case Report and Review of Related Literature. 2021. [original]

Frankl, S, et al. Devastating Neurological Injury as a Result of Treatment of “Chronic Lyme Disease”. Mayo Clinic Proceedings. 2021.

Nasir S, et al. Non-alcoholic Wernicke’s encephalopathy: toxic ingestion or an honest mis-steak? J Community Hosp Intern Med Perspect. 2021.

Njie AB, et al. Peripherally Inserted Central Catheter-Associated Nocardia nova Endocarditis in a Patient Receiving Intravenous Antibiotics for Chronic Lyme Disease. Open Forum Infectious Diseases. 2021.

Trautmann A, Gascan H, Ghozzi R. Potential Patient-Reported Toxicities With Disulfiram Treatment in Late Disseminated Lyme Disease. Front Med (Lausanne). 2020. [Report from “Lyme literate” conspiracy theorists in France]