Pseudobulbar Affect and MS: Causes, Patient Information
Content created by Healthline and sponsored by our partners. For more details click here.
Content sponsored by our partners. More details »

This content is created by the Healthline editorial team and is funded by a third party sponsor. The content is objective, medically accurate, and adheres to Healthline's editorial standards and policies. The content is not directed, edited, approved, or otherwise influenced by the advertisers represented on this page, with exception of the potential recommendation of the broad topic area.

Read more about Healthline's advertising and sponsorship policy.

MS and the Pseudobulbar Affect

What Is the Pseudobulbar Affect?


  1. Pseudobulbar affect (PBA) is a condition in which you suddenly start to laugh or cry without being triggered by anything in particular.
  2. PBA often causes you to feel emotions completely unrelated to your mood or other emotions you’re feeling at the time of an episode.
  3. PBA differs from depression mainly in that PBA reactions are sudden. You can have PBA without depression.

Multiple sclerosis (MS) damages the nervous system, including the brain and spinal cord. The nervous system sends messages, or signals, between the brain and body to control bodily functions. Damage to this system can disrupt these signals.

Damage to the central nervous system by MS affects movement, feeling, vision, and even emotions.

Pseudobulbar affect (PBA) is a condition in which you suddenly start to laugh or cry (or have other emotional outbursts) without being triggered by anything in particular.

Normally, your cerebral cortex (at the front of your brain) communicates with your cerebellum (at the back of your brain) to control your emotional responses to situations. However, sometimes the cerebellum becomes damaged by lesions or nerve problems. This can disrupt communication between these two areas. PBA is thought to result from this miscommunication. Your brain “short circuits,” and you can no longer control your emotional response, which is called disinhibition.

According to the National Stroke Association, over 1 million people have PBA. PBA often affects people with nervous system conditions like MS.

Other Conditions with PBA

PBA can result from other conditions aside from MS. Nearly half of all people who have had a stroke will experience PBA at one time or another. PBA can also result from traumatic brain injuries, brain tumors, ADHD, Grave’s disease, Parkinson’s disease, and Alzheimer’s disease.

Symptoms of PBA


The most recognizable signs of PBA are inappropriate emotional responses. Sometimes called emotional incontinence, PBA can cause you to suddenly laugh at a sad situation like a funeral or suddenly start sobbing while someone’s telling a joke. PBA often causes you to feel emotions completely unrelated to your mood or other emotions you’re feeling at the time of an episode.

If you have MS, PBA may also occur alongside symptoms of depression. However, unlike depression, PBA is sudden and not necessarily connected to your mood or emotional state. Untangling the symptoms of PBA and depression can be difficult at first. Pay close attention to the suddenness of emotional responses to decide if you need to talk to your doctor about possible PBA.

Diagnosing PBA


Many people are never diagnosed with PBA because it can be hard distinguish it from other emotional issues. However, PBA comes with recognizable behaviors. The most common are sudden emotional reactions that have nothing to do with the situation you’re in.

See your doctor if you think you’re experiencing PBA. To decide if you have PBA, your doctor will ask you (and your loved ones) about your symptoms. Then, they may ask you a series of questions from The Center for Neurologic Study-Lability scale. They will assign you a score to find out whether you have PBA. If you do, you can discuss treatments for PBA.

Treatment for PBA


PBA can be treated with some medicines that treat depression and other mental health-related issues. These medicines include amitriptyline (Elavil), fluoxetine (Prozac), citalopram (Celexa), and fluvoxamine (Luvox). Recent research shows that both tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are effective treatments for PBA.

In 2010, the FDA approved a new drug called Nuedexta. This drug targets a chemical in the nervous system. It’s designed for PBA in people with MS and other nervous system disorders. Nuedexta mixes quinidine, which is used to treat heart arrhythmia, and dextromethorphan, which is a commonly used cough suppressant.

Antidepressants, SSRIs, and Nuedexta all have potential side effects. These treatments can also interact with other medicines. Talk to your doctor about other medications you’re taking before requesting Nuedexta or an antidepressant. Otherwise, you may have uncomfortable or painful side effects.

PBA is caused by dysfunction within the brain. However, certain habits and lifestyle changes can help lessen the effects of PBA. Using general relaxation techniques when you feel an episode coming on can help shorten the episode or help you avoid it completely. These techniques include deep breathing, quiet meditation, yoga, and even art and music therapy.



Talk to your doctor about the differences between depression and PBA. Both are commonly associated with MS. Both can be addressed with similar treatments. However, PBA differs from depression mainly in that PBA reactions are abrupt in onset. You can have PBA without depression. You can also have depression without PBA. Your doctor can help you understand the difference so that you can effectively manage your condition.

Be aware of your posture when you feel yourself starting to have an episode. Changing your posture can help you quickly stop an unwanted PBA reaction. Furthermore, focusing on relaxing muscles that feel tense before a PBA episode can help you avoid PBA symptoms.

Focus your mind on thoughts that contrast with the emotional response to help stop the effects of PBA. For example, think about something upbeat or funny when you feel the urge to cry. You may be able to avoid crying altogether.

Lastly, communicate openly and honestly with your friends, co-workers, and family about your PBA. This can help you cope with PBA more easily. At first, PBA can have an uncomfortable impact on your social life as you and those around you learn to recognize symptoms. However, discussing PBA behaviors with your friends and family may ease the anxiety of its symptoms. 

More Resources