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raysrightside

Pseudo bulbar syndrome out of control...

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When I had my initial stroke, my emotions were all over the place. Eventually they became somewhat manageable, and inappropriate outbursts were few and far between. I still had no filter, but I could keep it to myself, mostly.  Now with the recent brainstem stroke, it's extreme, I cry ugly and laugh hysterically at anything.  I may even consider medication. Will ask my Neuro what options I have next week.  What the Neuro always asks is if I am depressed.  Don't know why she always goes that direction, but I always stress that when fits of hysteria hit me, I'm not upset or depressed, something very minor has triggered an emotional response.  I am just not responding in an appropriate way. Now it's very loud and noticeable. I think I have to do something about it.

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I very much understand and relate. My bilateral cerebellar stroke was 4 years ago but my PBA never quite went away. For months after the stroke I had extreme fits of flipping back and forth (crying/laughing). I couldn't control it. It was exhausting. It is extremely difficult for others around me...they easily get upset because I easily get upset and want me to stop. They don't understand when I tell them "I can't control it". I have a wonderful Psychiatrist who has worked to help me for the past 3 years. I take Nuedexta specifically for PBA as well as antidepressants and anxiolytics for my severe GAD with panic disorder. It isn't perfect...I have breakthrough moments but I am so much better than I was. It is very expensive but the manufacturer has a program to help those who need financial assistance. I can see why you may have gotten much worse in this way after a brainstem stroke (posterior circulation). These types of strokes can disrupt differently than many other kinds. The cerebellum is also a posterior circulation stroke. I wish you all the best. I think Nuedexta is the only FDA approved drug available specifically for PBA. You may need to work closely with a Psychiatrist or Medical Dr familiar with using Nuedexta. Many have no experience with it but if you find the right Dr. who is really wanting and willing to learn and be of help it can be life changing. 

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When I was in the ICU last month my neurologist put me on seraquil for the pba but we both agreed to stop using it when the pba seemed to be lessening.  Well it's back with a vengeance so maybe I will get back on it. Going back to living alone may be causing the spikes in emotion though I've always been fairly independent. Maybe now that I have to ask for help occasionally, my mind is trying to compensate for not being able to do it all myself like I am used to.

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The reason they ask if you're depressed Ray is that pba or "emotional lability" as it is called here have different treatments, although often within the same group of drugs.  I'm on low dose lexapro for it, but they would use something else if I was depressed.  I find thinking of it as the feedback control circuit is broken is the easiest. Any emotion becomes expressed and not always as what you are feeling either. So feeling happy or loved can make you cry uncontrollably and then someone will try to comfort you and that only makes it worse because you feel even more of what set you off in the first place.

The reality of taking drugs for this is that you will probably be on the drugs for the rest of your life, the drugs replace the broken circuit so you don't learn to do it for yourself again.  I chose the drugs knowing this as I wanted to go back to work and you can't be emotionally labile in an office without offending someone sooner or later. So when I retire I'll think about weaning off the drugs and see if I can relearn the control.

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That's a much more lucid explanation than my neurologist provided, Heather. Thank you. I, too, will probably return to an office environment, and I need to get this situation under control. So for now, I will be persuing relief with medication.

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i have been on lexapro since my stroke, it helped so I was allowed to wean off of it for awhile.The sadness came back very strong and I went back on a lower dose.Now I am ok, but still fell a good cry come on every so often, usually not in public, thankfully.

Life is so different now.  

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Maybe I should consider this.  My emotions go very wobbly sometimes and my shrink has offered me various anti-depressants at times, but I guess that I'm a bit stupid (or stoic, or both) and prefer to not mess with my brain chemistry, given that it has had a major insult already from the stroke.  I'm mostly scared that it will slow me down even more and make the deficits worse.

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Paul, I grew up in a household where we were 'tough' and didn't even take a panadol for a headache. 

 

These days, it's like, bugger that!!

 

Everyone has great advice. Sounds like you are more than willing to take the advice you asked for, hat's off to you for that.

 

My 2c worth:

 

I don't think I have PBA.  I don't think I have depression. 

 

But I think I'm like Paul. 

 

It's sadness, and how deep the sadness gets. Then the hard road back from that sadness. 

 

So yes, I'm on lexapro as well.  It helps immensely. 

 

I often feel that I want to cry, but don't.   

 

I cried so much when this all first happened, I wonder if I actually have any tears left.

 

All the best with finding the right medication and dose.

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One of the things I like about the Lexapro is that I can and do still feel the emotions and I can have a "good cry" when I need to. but it's back under my control and I can stop crying when I'm done.  The crying that comes out of "nowhere" and can't be stopped is just horrible.  

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It's not all cloudy skies and rain, folks. Today as I was doing my 25 steps with my walker, I found myself taking a break next to the vacuum cleaner. Seeing some doggie fur on the carpet nearby, I decide to clean it up. Picture this...walker in one hand for stability, vacuum in the other picking up my doggie's hair. Giggled non-stop at the silly picture I must be making.

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Now that's a good image! Whatever else is going on, don't take life too seriously, because it's so often silly.

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Ray, that’s so awesome! You’ll have to post a picture of the culprit...love doggos!

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What a cutie patootie! No wonder you are happy vacuuming!

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