You get an uncontrollable fit of giggles in the middle of an employee review. Or you burst into tears while having an uneventful lunch with a friend.
If you’ve experienced these types of sudden, exaggerated, or inappropriate displays of emotion after a traumatic brain injury, or you’re living with a neurological disease, you may have a medical condition called pseudobulbar affect (PBA).
You’re also not alone. Anywhere from 1.8 million to 7.1 million people in the United States have trouble controlling their emotions due to a neurological injury or disease. PBA affects up to 37 percent of people with these types of conditions.
If your symptoms have only recently appeared, you probably have a lot of questions for your doctor. Use this article as a guide to help you talk to your doctor about PBA.
What is pseudobulbar affect (PBA)?
PBA is a condition that causes uncontrollable or extreme outbursts of emotion. Examples include laughing or crying in situations where it’s not appropriate, or being unable to stop laughing or crying.
What causes PBA?
PBA can happen in people who’ve had damage to their brain because of conditions like:
- Alzheimer’s disease
- Parkinson’s disease
- traumatic brain injury
- multiple sclerosis
- amyotrophic lateral sclerosis (ALS)
- brain tumors
Doctors don’t yet know exactly what causes PBA. It’s thought that the problem starts in your cerebellum — the region at the base of your brain. The cerebellum helps you walk and stay balanced, but it also plays an important role in your emotional responses.
Researchers believe the cerebellum helps keep your emotions in line with your mood and the situations you’re in. It’s what prevents you from laughing hysterically at a funeral or crying during a funny movie.
To gauge the situation, your cerebellum gets input from other parts of your brain. When those brain areas are damaged, your cerebellum can’t get the information it needs. So, you end up with exaggerated or inappropriate emotional displays.
What types of symptoms does PBA cause?
The main symptom of PBA is an emotional response that’s either more extreme than usual for you or out of place. For example, you might cry during a conversation with a friend, without feeling any sad emotions, or you might start to laugh uncontrollably during a sad movie.
With PBA, the laughter or crying lasts for several minutes or more — much longer than it normally would. You can’t control or stop the emotional outpouring. You might even react during situations that other people don’t find funny or sad, like laughing during a funeral.
Could it be that I’m depressed?
Crying is the most common manifestation of PBA, so it’s not surprising that it’s often mistaken for depression. They’re different conditions, although some people have depression and PBA together.
One way to tell which one you have is by the duration of your symptoms. PBA lasts only a few minutes at a time. Crying and feeling down for weeks to months at a time is more likely to be depression. Depression also comes with other symptoms, like trouble sleeping and appetite loss, which you won’t experience with PBA.
How will you diagnose me?
Neurologists, psychologists, and neuropsychologists diagnose PBA. To start, the doctor will ask questions about your symptoms.
You could be diagnosed with PBA if you’ve had a brain injury or disease and you:
- have emotional responses that don’t fit or are much too extreme for your situation or mood
- can’t control your laughter or crying
- don’t get relief when you cry
- respond in a way that you didn’t before (for example, you never cried during sad TV shows, but now you do)
- have symptoms that are embarrassing or that negatively impact your daily life
What are my treatment options?
Medication is your best bet for regaining control of your emotions. Until a few years ago, antidepressants were the drugs of choice for treating PBA. Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) can prevent you from having as many laughing and crying episodes, and make the ones you do have less severe.
Today, there’s also a drug that’s FDA-approved just for treating PBA. It’s called dextromethorphan hydrobromide and quinidine sulfate (Nuedexta). Studies show that Nuedexta cuts the number of laughing and crying episodes by about half. It also works faster than antidepressants.
What else can I do to manage PBA?
Living with emotions you can’t control can be stressful, especially when you’re at work or in social situations. If you have trouble coping, get help from a psychologist or other mental health professional.
While you’re in the middle of an episode, it can help to distract yourself. Picture a calming scene, like a beach, in your mind. Take slow, deep breaths. And try to relax your body until the emotions pass.