WE HAVE MANY ways to describe the fact that feelings are inherently changeable. In addition to "mood swings," we also refer to emotional instability, emotional instability, and even the more pejorative emotional incontinence. These terms overlap and are often used to refer to a phenomenon that we will call emotional release. Differing from the mood swings previously described, emotional release refers to instances in which a strong emotion seems to "take over" and overwhelm the person in a crescendo of feeling.
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For example, the person who is thinking or talking about a topic that generates a certain intensity of feeling suddenly becomes choked up and starts to cry. That person is not crying because the feeling of sadness or distress is so intense, but simply because the emotional buildup was strong enough to trigger a crying response that he or she is then unable to control. Although the phenomenon is usually over as quickly as it begins, it can create embarrassment and confusion in a person's professional life, and tension and misunderstandings at home. When emotional release occurs in the context of a family discussion or argument, the strong and sudden release of emotions may precipitate an escalation of the whole situation, leading to raised voices, anger, and alienation.
Although many people take this phenomenon for granted as part of their "personality," it is probably due, at least in part, to demyelination in brain centers that are related to the modulation of emotion. People who experience emotional release have found some simple strategies to be useful. The first step is to become aware of the buildup of feeling and the circumstances that tend to precipitate it. Once the person has developed some skill at this kind of self-monitoring, he or she is often able to catch emotional release in its very early stages, as the feelings are welling up but before they crescendo. At that point, the person attempts to take an emotional time-out, pausing for a few deep breaths, slowing or halting the conversation momentarily, and attempting to prevent the emotional reaction from getting out of hand. At times, we could all probably benefit from this strategy because it may carry the additional benefit of preventing the utterance of statements that are later regretted.
Uncontrollable Laughing And/Or Crying (Pseudobulbar Affect)
EMOTIONAL RELEASE INVOLVES the exaggeration of very real emotion. A different, relatively rare phenomenon involves the experience of episodes of laughing and/or crying that do not seem to be connected to any emotion. A seemingly insignificant or innocuous incident precipitates an uncontrollable bout of hilarious laughter or intense sobbing. The person does not feel happy or sad even though the emotional expression seems to suggest it. It is generally assumed that this phenomenon is a direct result of demyelination in parts of the brain that are responsible for the control of emotions.
Because these episodes are so unpredictable and disconnected from actual feelings, the strategies suggested for dealing with emotional release are not likely to be helpful. One group of researchers has found that the antidepressant amitriptyline can be helpful in controlling this unusual phenomenon. Preliminary findings from a large, placebo-controlled trial of Neurodex (a combination of dextromethorphan and quinidine) in people with MS, indicate that this drug may be a safe and effective alternative.
Although no studies have been published, anecdotal reports suggest that the SSRI antidepressants (e.g., fluoxetine (Prozac) and sertraline (Zoloft)) may also be useful in treating these episodes. For the family, these episodes can be particularly unnerving. However, by understanding the real nature of this unusual experience, family members may avoid labeling such behavior as "crazy" or deliberately disruptive. To find out more, you can check out Multiple Sclerosis Early Symptoms.