The Evidence for Symptomatic Treatments in ALS

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The Evidence for Symptomatic Treatments in ALS

Depression and Emotional Lability


Depression is common and psychological support is vital to patients and family members. Standard antidepressants and cognitive-behavioural approaches are used, but no RCTs specific to ALS exist.

We generally treat emotional lability, defined as sudden outbursts of tears or laughter incongruous to circumstance, with citalopram or tricyclic antidepressants. Evidence from RCTs supports the use of dextromethorphan/quinidine; although more experience is required to define long-term safety and efficacy, the combination is well tolerated.

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