title: Involuntary emotional expression disorder: treating the untreated.
abstract: Patients with involuntary emotional expression disorder (IEED) have impaired social and occupational functioning and there is currently no Food an Drug Administration-approved treatment. Treatment options include tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), dopaminergic agents, and a combination of dextromethorphan and quinidine. Studies of monaminergic agents have typically been small and executed in single-center settings. Assessment measures generally show significant symptomatic improvements, including a reduction in the number of laughing or crying episodes and improvements in patients' clinical condition. The tolerability profiles of these agents are well defined, and include dizziness, tachycardia and QTc prolongation (TCAs), and sleep and sexual disturbances (SSRIs). The combination of dextromethorphan and quinidine has also been assessed in two large multicenter studies in patients with amyotrophic lateral sclerosis and multiple sclerosis. Compared with placebo and either agent alone, there were significant improvements in symptoms, quality of life, and relationships. The most common side effects were dizziness and nausea, and potential drug interactions with quinidine should also be considered. Choice of treatment should be evidence-based, taking into account both efficacy and tolerability.
authors.affiliation: MDA/ALS Clinical Research Center at the University of Wisconsin, Madison, WI, USA.
authors.forename: Benjamin Rix
authors.initials: BR
authors.lastname: Brooks
mesh_terms: D000342:Affective Symptoms / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003915:Dextromethorphan / Q000009:adverse effects / Q000627:therapeutic use; D015259:Dopamine Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D011802:Quinidine / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D015259:Dopamine Agents; D011619:Psychotropic Drugs; D003915:Dextromethorphan; D011802:Quinidine