Several people from our Deep Brain Stimulation (DBS) support group approached me and expressed concerns about their expressions of “inappropriate” crying or tearfulness that did not coincide with their current mood. One woman said she found herself in tears when observing high school cheerleaders forming a pyramid. Coincidentally this woman was a high school cheerleader nearly 40 years ago. One man said that he had never been a crier until after DBS, and now he cries at happy or sad events, and that he often doesn’t know what triggers it. A few indicated that they become tearful when sharing their DBS stories.
Currently, I also find myself frequently tearful or crying at happy movies, sad movies, when receiving a compliment, when I see a cute baby, a beautiful sunrise, or for unknown reasons. I describe myself as “sentimental” since DBS. I figured it might be related to 15 years of repressed emotions while practicing as a Certified Public Accountant prior to my diagnosis of Parkinson's. In those years, I was proud that I never shed a tear in the line of duty.
Neuropsychologist, Paul Short, PhD, proposes that you ask yourself the following questions if you suspect that you may have a problem:
Do you sometimes find yourself crying in response to insignificant incidents?
Is the tendency to weep easily something that is new and uncharacteristic of you?
Is the tearful response uncontrollable and disproportionate to the event that set it off?
Does this crying occur when you were not feeling sad or depressed?
Is the outburst sometimes incongruent with the event that set it off, such as crying when one hears a funny joke or the converse such as inappropriate laughing when feeling sad or stressed?
Dr. Short indicated that if you answered yes to any of these questions, you may be experiencing a neurological phenomenon called Involuntary Emotional Expression Disorder (IEED) (also known as Pseudobulbar Affect (PBA) or Emotional Incontinence).
In my research of this topic, IEED is described as a condition when a person experiences uncontrollable episodes of emotional expression including crying, laughter or anger that doesn’t coincide with their present mood. The unpredictability of episodes of IEED can take an emotional toll, causing a person to avoid interacting with others, and it can be socially isolating and socially embarrassing if these episodes occur at inopportune times.
The crying episodes are different from the episodes of depression. With depression, people often lose interest in formerly enjoyed activities and frequently develop changes in sleep and appetite patterns. Depression can be all encompassing, particularly if untreated; however, with IEED, the episodes are unpredictable, short lived and intermittent.
IEDD is another one of those “non-motor” symptoms of Parkinson’s that isn't discussed. IEED is often present in patients with neurological disorders, with about 4%-15% of those with Parkinson’s experiencing this condition. I suspect that the percentage is higher for post-DBS patients, but I haven’t found any research to substantiate this. IEED is often under-diagnosed, as sometimes the symptoms mimic other clinical emotional disorders such as depression or bipolar disorder.
For many patients, IEED can be treated medically with Nuedexta. However, little or no testing of this drug has been done with Parkinson’s patients, and it may interact adversely with their current medications.
As for myself, I am carefully choosing my PD battles, and I am also reluctant to take an additional medication. I’m going to “learn to live with it” as I continue to describe myself as “sentimental,” which is not the worst label in the world that I could have.
Why Do I Cry? by Paul Short, PhD
April 14, 2011
A Flood of Emotions by Debra Gordon, M.S.
February-March 2012 - Volume 8 - Issue 1 - p 26–29http://journals.lww.com/neurologynow/Fulltext/2012/08010/A_Flood_of_Emotions__Treating_the_uncontrollable.19.aspx