What is the pseudobulbar affect?

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 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. It is also referred to as pathological laughing and crying.

Normally, your cerebral cortex (the front of your brain) communicates with your cerebellum (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 may affect people with nervous system conditions like MS, and may occur in up to 10 percent of people with MS, particularly those with secondary progressive multiple sclerosis.

Other conditions with PBA

PBA can also result from other conditions. Nearly half of all people who have had a stroke will experience PBA. PBA can also result from:

  • traumatic brain injuries
  • brain tumors
  • ADHD
  • Graves’ disease
  • Parkinson’s disease
  • Alzheimer’s disease

The most recognizable symptoms 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 is also described as defined as emotional expression that is exaggerated or incongruent with underlying mood. It often causes you to feel emotions 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 challenging. Pay close attention to the suddenness of emotional responses to decide if you need to talk to your doctor about possible PBA.

Many people are never diagnosed with PBA because it can be hard distinguish 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. Your doctor will ask you (and your loved ones) about your symptoms. And, ask you a series of questions before assigning you a score to find out if you have PBA. If you do, you can discuss treatments.

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 or avoid the episode. These techniques include:

  • deep breathing
  • quiet meditation
  • yoga
  • art and music therapy


In 2010, the Food and Drug Administration (FDA) approved a new drug called Nuedexta. It’s the first — and only — drug that’s approved by the FDA to treat PBA.

Nuedexta targets a chemical in the nervous system. It’s designed for PBA in people with MS and other conditions. Nuedexta mixes quinidine, which is used to treat heart arrhythmia, and dextromethorphan, which is a commonly used cough suppressant.

PBA can also be treated with some medicines used for depression and other mental health-related issues. These medicines include:

  • amitriptyline (Elavil)
  • fluoxetine (Prozac)
  • citalopram (Celexa)
  • fluvoxamine (Luvox)

Research shows that both tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are effective treatments for PBA.

Although antidepressants can help you manage your symptoms, they aren’t approved by the FDA to treat PBA. Using antidepressants to treat PBA is considered off-label drug usage.

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

Talk to your doctor about the differences between depression and PBA, which are both associated with MS. Both can be addressed with similar treatments. However, PBA differs from depression in that PBA reactions are abrupt in onset.

You can have PBA with or without depression. Your doctor can help you understand the difference so that you can effectively manage your condition.

Also, communicate with your friends, co-workers, and family about your PBA. This can help you cope more easily as you and those around you learn to recognize symptoms.