Are you or a friend experiencing bouts of uncontrollable crying or laughter? Are the episodes inappropriate or disproportionate to the situation at hand? What's going on? It's called "emotional incontinence" and occurs in 20-25 percent of people in the first year after a stroke.

Researchers have not yet pinpointed the exact cause of emotional incontinence after a stroke. One possibility is that a stroke damages areas of the brain that control emotions. This stroke damage can disrupt the function of a brain chemical called serotonin, which also plays a role in depression and other mental health problems such as anxiety. It’s also possible that the psychological stress of a stroke may be partly to blame for emotional incontinence.

Assuming that serotonin is at the root of emotional incontinence, some physicians prescribe antidepressants called serotonin reuptake inhibitors (SSRIs) to treat the problem. These medications increase serotonin levels in the brain. This approach appears to be helpful in some cases.

For example, in a 2006 study in the journal Stroke, 152 people diagnosed with post-stroke depression, proneness to anger, or emotional incontinence were randomly assigned to receive either the SSRI fluoxetine (Prozac) or a placebo for three months. The result: Treatment with Prozac among these stroke victims significantly improved emotional incontinence - especially for those who suffered from excessive or inappropriate crying.

If you’re interested in trying an antidepressant to control inappropriate crying or laughing, ask your doctor to refer you to a neurologist or a psychiatrist who specializes in stroke-related emotional problems. The National Stroke Association offers these suggestions for helping you or a loved one cope with emotional incontinence due to stroke.

• Don’t try to hide it from others. Let others know ahead of time that sometimes the emotions you express on the outside are not what you are feeling inside. By doing this, you won’t need to avoid social situations. In fact, maintaining social relationships is an important part of recovering from a stroke.
• If you feel an inappropriate emotion coming on, distract yourself. Focus on something boring or unrelated.
• Engage in activities that are incompatible with crying or laughing. For example, try relaxation techniques like deep breathing and progressive muscle relaxation to stifle an inappropriate emotion before it rears its head.
• Join a stroke support group. Just knowing that you are not alone and having someone else to share your concerns are comforting to many people.

Used with permission. For more information, see Johns Hopkins Medicine 2008 Hypertension and Stroke White Paper, http://www.johnshopkinshealthalerts.com/white_papers/hypertension_stroke_wp/digital08_landing.html, by Simeon Margolis, MD, PhD.