Pathological display of affect in patients with depression and right frontal brain damage. An alternative mechanism

J Nerv Ment Dis. 1987 Mar;175(3):165-72. doi: 10.1097/00005053-198703000-00007.


Two patients are reported with the acute onset of pathological crying following right inferior frontal brain damage. Both had severe endogenous depression and neither had pseudobulbar palsy. These and other cases argue that two organic brain diseases--one structural and the other "physiopharmacological"--may interact to produce pathological display of affect that cannot be accounted for by traditional neurological explanations. A pharmacological mechanism for the rapid amelioration of pathological affect by tricyclic medications and its possible relationship to the newly discovered descending motor systems of the brain that use norepinephrine and serotonin as neurotransmitters is offered. These cases also suggest that pathological affect is a valuable clinical indicator of an underlying major depression in some brain-injured patients.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Brain Neoplasms / surgery
  • Cerebrovascular Disorders / complications*
  • Cerebrovascular Disorders / diagnostic imaging
  • Cerebrovascular Disorders / physiopathology
  • Crying*
  • Depressive Disorder / complications
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / physiopathology
  • Diagnosis, Differential
  • Frontal Lobe / diagnostic imaging
  • Frontal Lobe / physiopathology*
  • Frontal Lobe / surgery
  • Humans
  • Male
  • Neural Pathways
  • Norepinephrine / physiology
  • Paralysis / diagnosis
  • Postoperative Complications / diagnosis
  • Postoperative Complications / diagnostic imaging
  • Postoperative Complications / physiopathology*
  • Serotonin / physiology
  • Tomography, X-Ray Computed


  • Serotonin
  • Norepinephrine