Pseudobulbar affect (PBA) causes episodes of uncontrollable laughter, crying, or other displays of emotion. These emotions are exaggerated for the situation — like sobbing during a mildly sad movie. Or, they can happen at inappropriate times, such as laughing at a funeral. The outbursts can be embarrassing enough to disrupt your work and social life.
PBA can affect people with brain injuries, as well as people living with neurological disorders like Alzheimer’s disease or multiple sclerosis. Its symptoms can also overlap with depression. Sometimes PBA and depression are hard to tell apart.
The main symptom of PBA is episodes of intense laughter or crying. These outbursts may not have anything to do with your mood or the situation you’re in.
Each episode lasts a few minutes or so. It’s hard to stop the laughter or tears, no matter how hard you try.
Pseudobulbar affect vs. depression
Crying from PBA can look like depression and is often misdiagnosed as a mood disorder. Also, people with PBA are more likely to be depressed than those without it. Both conditions can cause extreme bouts of crying. But although you can have PBA and depression at the same time, they aren’t the same.
One way to tell whether you have PBA or if you’re depressed is to consider how long your symptoms last. PBA episodes last for just a few minutes. Depression can go on for weeks or months. With depression, you’ll also have other symptoms, like trouble sleeping or appetite loss.
Your neurologist or psychologist can help diagnose you and figure out which condition you have.
Damage to the brain from an injury or a disease like Alzheimer’s or Parkinson’s causes PBA.
A part of your brain called the cerebellum normally acts as an emotional gatekeeper. It helps keep your emotions in check based on input from other parts of your brain.
Damage to the brain prevents the cerebellum from getting the signals it needs. As a result, your emotional responses become exaggerated or inappropriate.
A brain injury or neurological disease can make you more likely to get PBA. Risks include:
- traumatic brain injury
- brain tumors
- Alzheimer’s disease
- Parkinson’s disease
- amyotrophic lateral sclerosis (ALS)
- multiple sclerosis (MS)
There’s no cure for PBA, but that doesn’t mean you have to live with uncontrolled crying or laughter for the rest of your life. Sometimes the symptoms will improve or go away once you treat the condition that caused your PBA.
Medications can reduce the number of PBA episodes you have, or make them less intense.
Today, you have the option of taking dextromethorphan hydrobromide and quinidine sulfate (Nuedexta). In the past, your best option was to take one of these antidepressants:
- selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) or paroxetine (Paxil)
Nuedexta may work faster than antidepressants and have fewer side effects.
Nuedexta is the only drug approved by the Food and Drug Administration (FDA) to treat PBA. Antidepressants aren’t FDA-approved to treat PBA. When antidepressants are used for this condition, then that’s considered off-label drug usage.
Self-care during and after episodes
PBA episodes can be very upsetting and embarrassing. Yet, there are several things you can do to help yourself feel better when you have one:
Try distraction. Count the books on your shelf or the number of apps on your phone. Think of a calming beach scene. Write down a grocery list. Anything you can do to take your mind off your laughter or tears can help them stop sooner.
Breathe. Deep breathing exercises — breathing slowly in and out while you count to five — are another effective way to calm yourself down.
Put your emotions in reverse. If you’re crying, watch a funny movie. If you’re laughing, think of something sad. Sometimes, taking on the opposite mood to what you’re feeling can put the brakes on a PBA episode.
Do something fun. Both PBA and the condition that caused it can weigh heavily on your mind. Treat yourself to something you enjoy. Go for a walk in the woods, get a massage, or have dinner with friends who understand your condition.
When to seek help
If the episodes don’t stop and you feel overwhelmed, get professional help. See a psychologist, psychiatrist, or counselor for advice. You can also turn to the neurologist or other doctor who treats your PBA for tips on how to cope.
PBA isn’t curable, but you can manage the condition with medications and therapy. Treatments can reduce the number of episodes you get, and make the ones you do have less intense.