Caring for someone with pseudobulbar affect (PBA) is a rewarding but difficult job. In people with PBA, laughter or tears appear suddenly, unpredictably, and often at the most inopportune times. This can lead to a lot of uncertainty and frustration for the person you’re caring for — and for you.

If you’re caring for someone with PBA, it means you’re providing support for two conditions at once. That’s because PBA is caused by a brain injury, stroke, or disease like Alzheimer’s or Parkinson’s. You’re likely dealing with a wide variety of emotional and physical symptoms at once, and it’s understandable if you feel overwhelmed.

Learning about PBA and the conditions that cause it can make your job easier. And if you’re caring for your loved one, don’t forget to take good care of yourself too.

Handling PBA symptoms

PBA causes intense bursts of laughter or crying. Often these episodes happen at inappropriate times, which can cause embarrassment for both the person who has PBA and to anyone who’s with them.

Remember that your loved one can’t control their laughter or tears. Learning about the condition can make you more understanding when these episodes happen.

Be patient. Each PBA episode can take a few minutes. Try to ride it out without being judgmental.

To help the episode pass more quickly, distract the person. Counting often helps. Count the number of letters on a screen or stars in the sky. Encourage the person to breathe slowly and deeply until the laughter or tears pass.

How to support your loved one

There are treatments available to help people with PBA manage the condition. Medications can help reduce the number of episodes and make the ones they have less intense and upsetting.

The two main treatments for PBA are:

  • dextromethorphan hydrobromide and quinidine sulfate (Nuedexta)
  • antidepressants

If the person you’re caring for isn’t already on one of these drugs, encourage them to see their neurologist or the doctor who treats their condition to get a prescription.

Although antidepressants may be prescribed, Nuedexta is the only drug that the Food and Drug Administration (FDA) has approved to treat PBA. When antidepressants are used to treat PBA, then that’s considered off-label drug usage.

Crying episodes of PBA can look a lot like depression. That’s why PBA is often mistaken for depression. However, PBA lasts for only a few minutes at a time, while depression lasts for weeks or months. If you think your loved one is depressed, suggest they see a psychologist or therapist for counseling.

Supporting yourself as a caregiver

Caregiving isn’t an easy job. It often involves a lot of uncertainty and a lack of control. Studies find that caregiving can take a toll on both the body and mind, and cause a great deal of stress for those who do it on a daily basis.

When your focus is on your loved one, your own health can suffer. Many caregivers say they don’t sleep as well as they should, and they neglect healthy practices like eating a healthy diet and sleeping well. They’re also more likely to become depressed and use substances like alcohol or drugs to cope with the stresses of caregiving.

Don’t lose sight of your own needs while caring for someone else’s. The better you care for yourself, the better a caregiver you’ll be to your loved one.

Here are a few tips to support yourself while caregiving:

Set realistic goals. Don’t try to tackle every responsibility yourself. Each day, write down a list of tasks that you know you can accomplish. If you can’t get everything done, don’t beat yourself up over it. Move the unchecked items to the next day’s list.

Get help. Ask other friends or relatives to take over some or all of your responsibilities a few times a week. Have someone go to the grocery store or take your loved one to the doctor.

Find support. Join a support group at your local hospital, or through an organization like the Family Caregiver Alliance. Make an appointment with a therapist or psychologist if you feel overwhelmed.

Take time for you. Devoting 24 hours a day to someone else can be overwhelming. Carve out time each day to do something special for yourself. Read a book. Take a walk. Or go to the movies with friends.

Recognize the signs of stress and caregiver burnout (see next section). When you spot them, give yourself a break or get help. Set aside time each day to practice stress relieving techniques like meditation or yoga.

Recognizing the signs of caregiver burnout

Pushing yourself too hard to care for someone you love can leave you physically and emotionally drained. This bone-weary state is called caregiver burnout, and it puts you at greater risk for depression and illness.

Look for these symptoms of caregiver burnout:

  • you lose interest in activities you once loved
  • you get sick more often than usual
  • you feel exhausted — both emotionally and physically
  • you lose your temper more easily than you used to
  • you feel hopeless or helpless
  • you’ve gained or lost weight without trying
  • you’re not sleeping enough, or you’re sleeping too much
  • you have thoughts of harming yourself, or of harming the person in your care

If you experience these symptoms, get help from your primary care doctor, a psychologist, or a therapist.