Emotional lability

Emotional lability is a condition in which a person experiences rapid, uncontrolled shifts in emotional expression, often disproportionate to the triggering situation. The person may laugh or cry suddenly and find the emotional response difficult to stop, even when it does not match how they actually feel inside. It is distinct from depression, although the two can coexist.

Why it occurs after cardiac arrest

Emotional lability can be a direct consequence of hypoxic brain injury. The frontal lobes and connected brain structures play an important role in regulating emotional expression and inhibiting responses that are socially inappropriate or disproportionate to the situation. When these areas are damaged by oxygen deprivation during cardiac arrest, the normal suppression of emotional reflexes is reduced.

What it looks like

A survivor may:

• Burst into tears in situations where they did not feel upset
• Laugh uncontrollably at something that is only mildly amusing
• Switch rapidly between laughing and crying
• Find it very difficult to stop an emotional response once it has started
• Feel embarrassed or distressed by episodes they cannot control

It is important to distinguish emotional lability from an underlying mood disorder. In lability, the emotion expressed may not reflect the person's actual mood; they may cry but not feel sad.

Impact on daily life

Emotional lability can cause significant social embarrassment and may lead survivors to withdraw from social situations, work, or activities they would otherwise enjoy. It can also be distressing and confusing for family members to witness.

Management

If emotional lability is interfering with daily life, it is worth discussing with a GP or neurologist. Some antidepressant medications (particularly SSRIs) have been found to reduce the frequency and intensity of episodes. Psychological approaches can help the person manage situations that tend to trigger episodes and reduce associated shame or embarrassment.