It was a joyous night. This dinner was one of my first social encounters since having my stroke. I had been a recluse for months and everybody I knew was happy to see me. The small crowd of people gathered in the dining room for mealtime as one of the attendees asked for everyone’s attention.
“I want to get this out of the way,” he said, “just to clear the air.” His eyes welled up with tears. “I lost my job today. With people asking me about work, I thought it was unkind not to tell the truth.” Suddenly, he started sobbing. He leaned onto his wife’s shoulder. They had three children to support, and his wife only worked part-time.
The news was painfully sad, but as soon as the man stopped talking, I started to giggle. The giggling soon turned into raucous laughter. I was embarrassed, and my friends were in shock. All I could do was push my wheelchair away from the table and go to the living room. I self-diagnosed this uncontrollable laughter as my brain short-circuiting. I assumed it had to do something with the stroke I had a few months prior.
I stayed in the living room for an hour. Once dessert was served, the laughter stopped. I went back to the dining room, but the mood had been spoiled. I could read the disdain on everybody’s face. The friend who brought me to the dinner drove me home in an eerie silence.
It happened again a few days later when I was out shopping with another friend. We went into a fitting room to try on a few items. The first thing I tried on was a plush velveteen red sweater. Red is my favorite color. The sweater looked good on me and was in my price range, so I should have been happy. But I started to bawl like a baby. My friend was alarmed by my tears. She thought I was losing my mind. We left the fitting room and clothing behind.
After that, I knew something wasn’t right. I went to the doctor a week later and told him about my involuntary laughing and crying. He said that it was pseudobulbar affect (PBA), and I had it because of my stroke. PBA is a secondary neurologic condition that causes sudden, frequent, and uncontrollable episodes of laughing or crying that don’t match how you feel.
He went on to tell me that neurological diseases like multiple sclerosis (MS), Alzheimer’s, and Parkinson’s disease can lead to PBA. A traumatic brain injury can lead to PBA, as well. He stressed that having PBA doesn’t mean I’m crazy — it means I’m injured.
I was one of the lucky ones because my PBA subsided after three years. It only comes back now in high-stress situations, which I try to avoid as much as possible.
There are treatment options for PBA. These include tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), dopamine agonists, and a combination of dextromethorphan and quinidine (Nuedexta). If you have PBA, schedule an appointment with your doctor to discuss these treatment options and what’s best for you.
Personally, I wanted to treat my PBA without drugs. It took a lot of hard work. For me, the worst thing to do was to refrain from social activity. The more social interactions I had, the more I was able to control my PBA episodes.
Communicate with others about your condition to help them understand. Let them know that you don’t have control over your outbursts and that you’re having a PBA episode. Please think of it that way. It’s annoying and embarrassing, but it’s not forever.
Good luck to all of you living with PBA. More than likely, your PBA will subside over time as mine did.
Joyce Hoffman is a former consumer columnist for the Philadelphia Daily News. She is also the author of “Here’s to Your Health: The Sobering Facts About Social Drinking,” and most recently, “The Tales of a Stroke Patient.” Hoffman is also a college professor and has taught students for the past 25 years. She has also worked as a technology and corporate trainer for the last 20 years, most recently with Cozen O’Connor in Philadelphia. She is available as a public speaker on strokes.