Medical - I was SEVERELY depressed and a complete mess when I first started treatment, that's why my LLMD put me on 1.5mg LDN. I was hysterically crying every day, very up and down. I have dealt with severe depression my entire life, have been suicidal at times, used to cut myself, had panic attacks, constant nightmares, and had an eating disorder from high school to my 20s. Most of this was from the childhood trauma I experienced, but some of it could absolutely be from Lyme too.
So yes, I definitely experience an increase in psych symptoms when I herx, BUT -- I also experience severe flashbacks when I herx (from childhood trauma). If you have any kind of previous trauma it is going to come to the surface while treating. If you don't think you have trauma then take the ACE questionnaire. My ACE score is a 9 out of 10, and I always tried to convince myself my childhood was "normal."
https://acestoohigh.com/got-your-ace-score/The LDN made a huge, overnight improvement in my mood. It took away decades of depression, so it might be something to consider. I have never been willing to take anti-depressants or other anxiety meds.
I still have bad days though, including today. My LLMD has offered me many options, she definitely wants me back in therapy (I can't find a new therapist thanks to Covid), and she always tells me to detox more when I'm depressed and having flashbacks.
Today I had a severe hour-long flashback where I fell down a few times. This is pretty standard for my flashbacks, and actually has nothing to do with Lyme.
You're definitely not alone in dealing with this type of stuff.
I also do things like EFT tapping, vagus nerve exercises, and TRE, to calm myself down. It's still a daily struggle and I definitely need to get back into therapy.