From the Guidelines
Treatment for emotional lability typically involves a combination of medication, therapy, and lifestyle adjustments, with selective serotonin reuptake inhibitors (SSRIs) like sertraline or fluoxetine often being first-line medications, and dextromethorphan/quinidine being specifically approved for more immediate control in neurological conditions like pseudobulbar affect. The most recent and highest quality study 1 provides evidence for the management of adult stroke rehabilitation care, including the treatment of emotional lability. According to this study, pharmacotherapy for emotional lability is recommended, with a quality of evidence rated as "Good" and a recommendation rating of "A".
Some key points to consider in the treatment of emotional lability include:
- The use of SSRIs like sertraline (50-200 mg daily) or fluoxetine (20-80 mg daily) as first-line medications, which usually require 4-6 weeks to reach full effectiveness 1
- The use of tricyclic antidepressants such as amitriptyline (25-150 mg daily) or desipramine (100-300 mg daily) as alternative options 1
- The use of dextromethorphan/quinidine (Nuedexta, 20/10 mg twice daily) for more immediate control, especially in neurological conditions like pseudobulbar affect 1
- The importance of cognitive behavioral therapy (CBT) sessions, typically 12-16 weekly sessions, to help patients identify emotional triggers and develop coping strategies 1
- The benefits of mindfulness practices and relaxation techniques like deep breathing exercises performed daily to improve emotional regulation 1
- The importance of adequate sleep (7-9 hours nightly), regular physical activity (at least 150 minutes weekly), and avoiding alcohol and stimulants as supportive measures 1
It's worth noting that the treatment of emotional lability should be individualized and tailored to the specific needs and circumstances of each patient. A comprehensive treatment plan should take into account the patient's medical history, current symptoms, and personal preferences, and may involve a combination of medication, therapy, and lifestyle adjustments.
From the FDA Drug Label
The following additional adverse events were reported by greater than 1% but less than 5% of the 358 patients treated with divalproex sodium in the controlled trials of complex partial seizures: ... Nervous System: Anxiety, confusion, abnormal gait, paresthesia, hypertonia, incoordination, abnormal dreams, personality disorder. Table 2 lists treatment-emergent adverse events which were reported by ≥ 5% of divalproex sodium-treated patients and for which the incidence was greater than in the placebo group, in a placebo-controlled trial of adjunctive therapy for the treatment of complex partial seizures ... Nervous System ... Emotional Lability64
The treatment for emotional lability (mood swings) is not directly stated in the drug label. However, valproate is sometimes used to treat mood swings and other mood disorders.
- Key points:
- Valproate may be used to treat certain conditions that involve mood swings.
- The drug label does not provide direct guidance on treating emotional lability.
- Valproate has been reported to cause emotional lability as an adverse event in some patients 2.
From the Research
Treatment Options for Emotional Lability
The treatment for emotional lability, also known as mood swings, can be approached through various methods, including pharmacologic and non-pharmacologic interventions.
- Pharmacologic Interventions: Studies have shown that selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine 3, 4, paroxetine 5, and fluvoxamine 6 can be effective in treating emotional lability. These medications have been found to improve symptoms of emotional lability in patients with brain injury, cerebrovascular accidents, and other conditions.
- Non-Pharmacologic Interventions: While the provided studies focus primarily on pharmacologic interventions, a meta-analysis suggests that both pharmacologic and non-pharmacologic treatments can be effective for emotional lability, with similar effect sizes 7. This implies that behavioral treatments may also play a significant role in managing emotional lability.
- Effectiveness and Response Time: The response to treatment with SSRIs can be rapid, with improvements observed within a few days to a week 3, 4, 6. This swift response suggests that SSRIs may be a useful treatment option for emotional lability.
- Implications for Clinical Practice: The findings from these studies have implications for clinical practice, suggesting that SSRIs and possibly other treatments could be considered for patients experiencing emotional lability, regardless of the underlying diagnosis 7.