Where’s a Straight Jacket When You Need One?
May 9, 2008 by kfabrizio
Word of the Day: Emotional Lability. Ok, so those are two words. Who out there is ready to argue with a gal who’d not fit for public consumption these days? I stole the phrase: “not fit for public consumption” from Ms. Brain Cheese herself – from a prior posting about her own experiences with Solumedrol and Prednisone. The posting hit the nail right on the head.
What exactly is emotional lability? Our good friends at Wikipedia share the following:
Labile affect or pseudobulbar affect refers to the pathological expression of laughter, crying, or smiling. It is also known as emotional lability, pathological laughter and crying, emotional incontinence, or, more recently, involuntary emotional expression disorder (IEED).[1] Patients may find themselves laughing uncontrollably at something that is only moderately funny, being unable to stop themselves for several minutes. Episodes may also be mood-incongruent: a patient might laugh uncontrollably when angry or frustrated, for example.
Labile affect is most commonly observed after brain injury or degeneration in amyotrophic lateral sclerosis (also known as Lou Gehrig disease), a form of motor neuron disease. It affects up to 50% of patients or up to 17,000 people, particularly those with pseudobulbar palsy.[2]It also occurs in approximately 10% of multiple sclerosis patients[3], signaling a degree of cognitive impairment.
While not as profoundly disabling as the physical symptoms of these diseases, labile affect can have a significant impact on individuals’ social functioning and their relationships with others. In motor neuron disease, the majority of patients are cognitively normal; however, the appearance of uncontrollable emotions is commonly associated with learning disabilities. This may lead to severe embarrassment and avoidance of social interactions for the patient, which in turn has an impact on their coping mechanisms and their careers.
Treatment for labile affect is usually pharmacological, using antidepressants such as fluoxetine, citalopram, or amitriptyline in low to moderate doses. In the USA, a combination of dextromethorphan and a subtherapeutic dose of quinidine has been submitted to the FDA for approval to treat emotional lability.[2]
Apparently the labile affect is highly prominent with people on high doses of Solumedrol and/or a Prednisone taper as well. Luckily the affect is temporary and completely curable once the steroids finally pass through the patient’s system (over a period of weeks). The hubby has now truly experienced what it would be like living with someone with Roid-rage. It’s a good thing I’m not a card-carrying member of the World Wrestling Federation (although since the steroids have altered my voice to a husky, rasp, maybe I should call for a job interview).
My emotions are certainly not my own. I don’t truly “own” any part of myself right now. For a control-freak, this is unsettling and disturbing. I’m merely trying to be quiet, stay quiet, and stay out of the range of anyone whom I may offend with my exhausted state of hypertension and sometimes immediate and unexpected withdrawal. People can tell I’m not myself these days, but I’d rather have folks wondering why I’m slightly withdrawn and quiet vs. watching me laugh, cry, and fret one moment after the other in public.
Luckily the hubby is a patient being, understanding that this “process” is really of no fault of my own (hint, hint – little reminder there hubby). Hopefully other caregivers to M.S. patients realize the ramifications of a little Solumedrol drip-trip as well on their loved ones.
Not fit for public consumption…there’s no better way to explain it!
In an effort to save my marriage, family, finances and sanity I refused the steriods this past episode. I experienced roid-rage the last time and let me tell you it was ugly. I could not stand to be around myself I can’t imagine how difficult it was for my husband and children.
The only good thing that came out of it: husband told me to leave the house (he implied it would be considered justifiable homicide if I did not). I got in my car, drove to our local furniture store, walked up to a sales person and clearly stated “I will purchase that bedroom set!” Stroked out the check, drove to the nearest ice cream store indulged in some chocolate chip cookie dough ice cream. Went home and went to bed…did not tell hubby about the new bedroom set for a couple of days, I think it was after they called to set up a delivery time.
⁃ Word of the Day: Emotional Lability.
Well, actually that’s two words.
Sorry. I couldn’t resist, which is doubly evil since I’m not completely sure whether that will make you laugh and not cry, or both!
I vividly remember the intense roller coaster Solumedrol feelings and thinking, “OMFG! THIS is how it must feel to have PMS. I get it!!!” Since I’ve never had PMS, I’m not sure if that’s actually the case or not. Maybe some day you can compare and contrast those two states, but I certainly did have a new sense of appreciation of what y’all have to go through each month.
I remember feeling very, VERY RAW. Every emotion, no matter how mundane, was no longer under the surface but laying right on top, unprotected. And every emotion, no matter how ordinary, was suddenly HUGE! GIGANTIC!! And they changed from minute to minute.
I walked around on the verge of tears, with actual tears in my eyes, much of the time. Even when I got used to what was happening and had a pretty good grip on why, my raging emotions were all still right there and vulnerable. Just because I knew what was up didn’t make them any less raw or any less intense. The simple question of what I wanted for lunch could bring me to a good sob because the decision was too daunting or perhaps because the thought of my favorite sandwich was so delightful that it made me cry. Or both. How to choose?!
Oh boy. Your husband is a trooper.
For you, I recommend Brian Eno’s ambient series of albums and chamomile tea.
Take care.
xx,
patrick