Antidepressant Treatment of Pathologic Laughing or Crying in Elderly Stroke Patients

Abstract

Pathologic laughing or crying (PLC), a complication of many neurologic disorders, involves behavior that is either inappropriate to the context or to the patient's subjective feeling state. It is due to a dysregulation of the motoric components of emotional experience. PLC is distinct from, but often associated with, major depression. The relatively few reports on treatment of PLC are primarily with tricyclic antidepressants. We report the effective treatment of PLC due to stroke in three patients with nortriptyline or fluoxetine. The cases also illustrate the broad spectrum of depressive symptoms (from none to a major depression) seen in patients with PLC. We discuss treatment implications and directions for future research.

Emotional side-effects of selective serotonin reuptake inhibitors: qualitative study

“…The SSRI group reported significant reductions in 12 of the 18 aspects, including ability to cry, irritation, care about others' feelings, sadness, creativity, surprise, anger, expression of their feelings and worry, which fits well with our results. Our finding that the intensity of emotions, including negative emotions, is reduced, and that emotional responses are accordingly more easily controlled, fits with reports of SSRI-induced inability to cry, 3 reduction in irritability, aggression and negative affect 7 and reduced emotional lability resulting from cerebrovascular accident 8 or other brain injury. 9 In addition, our key theme of ‘no longer caring’ fits with several case reports and one case–control study of SSRI-induced changes, including apathy, indifference, and reduced motivation, in children, adolescents, adults and older adults.…”

Depression after stroke: a review of the evidence base to inform the development of an integrated care pathway. Part 2: Treatment alternatives

“…Apart from isolated case studies [52][53][54] there are four controlled trials of TCAs and SSRIs in poststroke emotional lability, which are listed in Table 2. [55][56][57][58] Illustrating the dif culty in separating post-stroke lability from PSD, half the patients in Robinson's series had major depression (DSM-III criteria) as well.…”

Pseudobulbar affect: the spectrum of clinical presentations, etiologies and treatments

“…However, the response of PBA to an antidepressant has often been observed within a few days after initiation of treatment [21][22][23], much sooner than would be expected for an antidepressant effect [24]. Moreover, response to an antidepressant has been reported for laughing as well as crying episodes [25].…”