From the Guidelines
Treatment for emotional lability post-stroke should involve a therapeutic trial of an SSRI or dextromethorphan/quinidine, as recommended by the American Heart Association/American Stroke Association guidelines. This approach is based on the most recent and highest quality evidence available, which suggests that these medications can be effective in managing emotional lability and pseudobulbar affect in patients with stroke 1.
When considering treatment options, it is essential to prioritize the patient's quality of life, morbidity, and mortality. In this case, the use of SSRIs or dextromethorphan/quinidine has been shown to be a reasonable and effective approach for managing emotional lability, with a recommendation level of IIa/A 1.
Some key points to consider when treating emotional lability post-stroke include:
- The importance of routine screening for poststroke depression using a structured depression inventory, such as the Patient Health Questionnaire-2 1
- The need for patient education and counseling to help patients and caregivers understand the neurological basis of emotional lability 1
- The potential benefits of combining pharmacological and nonpharmacological treatments, such as cognitive behavioral therapy and exercise programs, to manage poststroke depression and emotional lability 1
- The importance of periodic reassessment of depression, anxiety, and other psychiatric symptoms to ensure optimal management and treatment outcomes 1
Overall, the goal of treatment for emotional lability post-stroke should be to improve the patient's quality of life, reduce morbidity, and minimize mortality, while also addressing the underlying neurological causes of emotional lability. By following the recommended guidelines and prioritizing the patient's needs, healthcare providers can provide effective and compassionate care for patients with emotional lability post-stroke.
From the Research
Treatment for Emotional Lability Post Stroke
- Emotional lability post stroke can be treated with selective serotonin reuptake inhibitors (SSRIs) 2, 3, 4, 5, 6
- A study found that 50 mg of sertraline per day may be an effective and well-tolerated treatment for stroke-associated lability of mood in the absence of depression 2
- SSRIs have been shown to improve recovery after stroke, even in people who are not depressed 4, 5
- A meta-analysis found that SSRIs reduced the average depression score and improved neurological deficit, but had no significant effect on disability score or independence 4
- Another study found that SSRIs appeared to improve dependence, disability, neurological impairment, anxiety, and depression after stroke, but there was heterogeneity between trials and methodological limitations 5
- SSRIs have also been shown to prevent emotional lability in healthy subjects 6
Benefits and Risks of SSRIs
- Benefits of SSRIs include improved recovery after stroke, reduced depression and anxiety, and improved neurological deficit 4, 5
- Risks of SSRIs include gastrointestinal side effects, seizures, and bleeding 4, 5
- SSRIs have a good tolerability profile and low fatal toxicity 3