Motor Neurone Disease (MND)

Emotional lability, depression and low mood with MND

Emotional lability and depression are two distinct conditions affecting some people with MND. Treatments are available for to help manage both emotional lability and depression.​ Depression may be experienced in reaction to the diagnosis or the challenges of the disease and it is quite normal for people living with MND to feel low at times. Emotional lability is a term used to describe a tendency to laugh or cry unexpectedly at what might seem the wrong moment.

Emotional lability is often a temporary symptom that reduces over time. It is more common to experience emotional lability if your ability to think and reason have been affected. However, it does not necessarily mean that other changes to thinking and reasoning will happen.

People talked to us about a range of emotional changes and disturbances. One woman who had experienced emotional lability said she had quite liked the euphoria of laughing but the crying was distressing.

Looking back, some people thought they had experienced emotional changes before diagnosis, though at the time they might not have realised or understood it. One woman said, “I would laugh or cry excessively and it bewildered and disturbed me because I couldn't work out why it was happening.” One man said his wife's emotions had become very changeable well before diagnosis.

Emotional lability is marked by emotional behaviours which are in some way out of proportion or inappropriate to the situation, for example laughing at things which are not funny or crying when someone tells a joke. These behaviours are not always accompanied by a true feeling or emotion, but sometimes the act of laughing or crying can in itself make one happy or sad. Therefore it is perfectly possible to have emotional lability but to have a normal mood. When an antidepressant is prescribed for emotional lability, it is thought it has a specific chemical effect which is different from the mechanism for treating depression. The doses used for emotional lability are usually lower than for depression. However, there is some doubt about how effective antidepressant use is with emotional lability.

Low mood is a natural and understandable reaction to a serious diagnosis such as MND. Not surprisingly, many people described feelings of intense sadness, bleakness and loss of hope, especially straight after diagnosis. (See also 'Immediate reactions to diagnosis'). Over time, many said these feelings became less intense, or they managed to push them to the back of their mind most of the time, but they could still become emotional very easily. Some made the point that this was different to emotional lability and was just a normal response to a serious life event. Both frustration and sadness played a part, and worries about the future. Several people said they were grieving for the loss of physical functions and the life they had expected to have.

Several men in particular said they had become generally more emotional or less 'macho' than they had ever been before. While they did not mind this in some ways, they could find it uncomfortable in public. As one man put it, “I'm not ashamed of my emotions. I cry in public. I don't like crying in public, but when you have motor neurone it's one of the things.' 

Some people became depressed. In depression, people may experience severe mood disturbance with significant physical and psychological results (insomnia, weight loss, irritability, feelings of hopelessness). These symptoms may respond well to treatment, even if they have been triggered by a life-altering physical illness such as MND. Some neurologists and GPs will be experienced in the management of depression, but where there is doubt a specialist psychological assessment may be helpful. Some MND or neurological clinics have a clinical psychologist as part of the multidisciplinary team. Several people we talked to found antidepressant medication helped them, and some were taking a low dose on a continuing basis. Some also benefited from talking therapies such as counselling and psychotherapy, and meditation.

One man started taking a drug called amitriptyline to help reduce excess saliva. Amitriptyline is in fact an antidepressant, and he found it reduced his emotional agitation as well as helping with the saliva.

Some people did not want or need to take medication and found other ways to get through periods of low mood. Strategies included expressing their feelings and talking it through with family; keeping up as many activities as possible and getting out regularly; going on holidays or trips; and consciously challenging negative thoughts. Some people used these strategies as well as medication.

People talk more about their general approach to life with MND and how they cope emotionally in 'Philosophy, attitude to life and messages for others'.

Carers will understandably also go through periods of depression. Carers' feelings are explored further in 'Impact on family carers'.

The MND Association website provides an information sheet to help: 9C: Managing emotions, which includes information about emotional lability.

Last reviewed August 2017.
Last updated
August 2017.

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