Mood instability is an intense or rapidly changing emotional response that is disproportionate to the current situation. This can be due to drastic changes in thoughts and behavior. Mood lability is associated with a variety of conditions, including borderline personality disorder and pseudobulbar affect (PAD), which can occur due to neurological problems, such as after a stroke.
What is a labile mood?
While mood swings can be completely normal, caused by stress and / or part of a struggle with a physical health condition, lability in mood can also be a symptom of mental illness.
Labile moods appear as rapid changes in emotions that are not related to external factors or seem inappropriate for the situation. A person with an unstable mood often feels that they cannot control their emotions.
The variety of terms used to describe these symptoms and the conditions associated with them has caused some confusion among sufferers as well as in the medical field. Some other terms used to describe lability of mood include:
- Involuntary emotional expression disorder
- Affective instability
- Emotional instability or dysregulation
- Pseudobulbar affect (when it comes to mood lability due to certain neurological disorders or brain injury)
The main symptoms of mood lability are sudden, exaggerated, unpredictable, or uncontrollable changes in mood and emotions. These are usually exaggerated or overly strong emotional reactions.
Other symptoms of mood lability include:
- Brief emotional outbursts that last no more than a few minutes.
- Mixed emotional states, such as laughter that turns into crying.
- Laugh or cry in situations other people don't find funny or sad.
- Emotional reactions that do not fit the situation.
- Emotional outbursts that are not typical of the character.
If you're not sure if you're in a labile mood, it's a good idea to keep a journal to keep track of your episodes and your mood in between. This journal will give you an idea of how frequent, unstable, and extreme your emotional outbursts are.
Intense, rapid, and frequent mood swings are often seen in conditions such as:
- Borderline personality disorder (BPD)
- Bipolar disorder
- Post traumatic stress disorder (PTSD)
Mood instability in PBA is often associated with conditions that affect the brain and neurological system.
Conditions commonly associated with PBA include:
PBA is believed to develop when the neural pathways that control emotions are disrupted, resulting in a loss of control over emotional responses.
What is the pseudobulbar effect?
Also known as pathological laughter, PBA causes occasional bursts of laughter or crying. Many people who experience this condition begin to avoid social situations and isolate themselves from others.
Although there is no specific test to diagnose mood lability, your healthcare provider will ask you a series of questions about your medical history and mood to confirm the diagnosis. Your healthcare provider will ask about the events associated with your symptoms, about other accompanying symptoms, and the duration and intensity of your emotional outbursts.
Exclusion of medical conditions
Sometimes blood tests or imaging tests may be ordered to rule out conditions that may be contributing to symptoms.
You can also have a mental health exam to help your healthcare provider identify a mental disorder.
If you think you have PBA, talk to your doctor. PBA is often mistaken for depression because some symptoms, such as crying spells, are similar.
There are also two types of questionnaires that help doctors diagnose pseudobulbar affect:
- The Pathological Laughter and Cry Scale (PLACS) that the doctor uses to talk with the patient.
- Center for Neurological Research – Lability Scale (CNS – LS) , which is a self-report questionnaire.
If you have mild symptoms of lazy mood and this does not affect your daily life, you may not need medication. But if your mood swings are extremely variable or reflect an underlying mental illness, then medication, therapy, or a combination of both can help.
Dextromethorphan hydrobromide and quinidine sulfate (Nuedexta) are currently the only drugs approved by the FDA for the treatment of PBA. Clinical studies in people with neurological diseases have shown that it reduces the frequency of emotional outbursts by about half.
Antidepressants such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), mood stabilizers, and atypical antipsychotics can help reduce the frequency and severity of episodes of labile mood, and your doctor may prescribe one of these treatments.
Psychotherapy (talk therapy) can help you learn to manage your emotions and urges to express yourself in healthy ways. From learning new coping skills to better understanding your emotional triggers, you will be better equipped to deal with aspects of your mood lability.
There are several coping mechanisms that you can use to help relieve symptoms and help your loved ones understand what you are going through:
- Be open about your symptoms and your condition with family and friends so they won't be surprised when you have a seizure.
- Take slow, deep breaths when you feel like a seizure is about to start.
- If you feel like you are about to experience an emotional outburst, try to distract yourself by counting nearby objects to focus your mind on something else.
- Do a quick head-to-toe body relaxation exercise before the attack.
- Find out what triggers your attacks, be it stress, fatigue, or frustration.
- If you have an episode, don't worry about it and berate yourself for it.
Get the word of drug information
If you or someone close to you is experiencing intense or rapidly changing emotional responses that are out of proportion to your current situation, talk to your doctor. If you are diagnosed with mood lability, you can work with a team of mental health professionals to understand what causes it and find ways to manage your mood.