The Journal of Psychiatry and Neuroscience (Canadian,
bilingual), an open-access publication, has a regular column entitled
Psychopharmacology for the Clinician (Psychopharmacologie
pratique). Typically the column contains a case
report and a brief discussion of practical issues in treatment.
The most recent (September 2007) issue describes a case of poststroke
pathological laughing and crying (PLC). PLC is a mysterious
condition, something that is impossible to explain using behavioral or
psychodynamic theory.
After a stroke, 7 to 48 percent of patients experience disinhibition of
emotional displays, including crying and/or laughing. In some
patients, the threshold for activation of these displays is reduced.
In others, the displays appear to be entirely spontaneous.
It is not directly harmful, but it is annoying. Moreover, it
can lead to some degree of disability because it can be disruptive.
Note that this is not due to poststroke depression or mania.
Although affective disorders commonly occur after stroke, PLC
is not associated with a full set of symptoms that would support a
diagnosis of mania or depression.
Now, you might think that an antidepressant would not have any effect,
since the patients do not have depression.
However, such expectations next to useless in psychiatry. The
only way to learn anything in psychiatry is to try it and see what
happens. So, what happens when a person with PLC takes an
antidepressant?
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