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Treating Involuntary Crying and Laughing

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6 Tips for Caregivers of Pseudobulbar Affect

Medically Reviewed By Heidi Moawad, M.D.

If you’ve been caring for a person with a neurological condition like Alzheimer’s disease, you might have noticed sudden laughter or tears. They don’t know why they’re laughing or crying and can’t control it. These episodes are called pseudobulbar affect (PBA).

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Pseudobulbar affect can occur with a condition such as:

  • Alzheimer’s disease
  • amyotrophic lateral sclerosis (ALS)
  • multiple sclerosis (MS)
  • Parkinson’s disease
  • stroke
  • traumatic brain injury (TBI)

Although it’s not the same as depression, research from 2020 Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source suggests that PBA is often misdiagnosed as depression. PBA is a neurological condition resulting from changes in the brain that disrupt nerve communication. Understanding PBA may help ensure your loved one gets the correct care.

1. Understand why they’re laughing or crying

Your loved one might cry or laugh at an unexpected time. You can navigate the experience by remembering what’s happening. They’re not laughing at you or anyone else. Similarly, they’re not crying because they’re sad over something happening at that exact moment. It’s in response to a nervous system disorder, and they cannot control when the episodes occur.

2. Help your loved one

Your loved one might get upset about crying or laughing unexpectedly. If that happens, you can try to comfort them and reassure them. You can help them find a quiet place to recover from the episode if they prefer. You can also encourage them to try some breathing strategies. For example, they could take a series of slow, deep breaths to help them try to relax, which might reduce the laughing or crying. They could try to move their bodies since movement can sometimes help. Or they could try a distraction strategy, like counting the number of books on a nearby shelf or cars driving by.

3. Identify triggers

You might also track PBA episodes to see what might prompt the crying or laughing. If you notice trends, make a note. Now you can watch out for those potential triggers. Similarly, if your loved one can track their episodes, they could write them down. This can help them identify potential triggers.

4. Explain the situation to others

People who experience PBA are sometimes embarrassed when they begin to laugh or cry uncontrollably in public. Explaining to others about the condition may help. It may be impossible to explain it to everyone, but you could educate people they regularly encounter, like co-workers, neighbors, or faith community members. Preparing them might prevent adverse reactions from others and keep your loved one from withdrawing from their social activities and feeling isolated.

5. Find treatment options

Consider talking with your loved one’s doctors about possible treatments. Until a few years ago, there wasn’t a medical treatment for PBA. However, the Food and Drug Administration (FDA) approved Nuedexta (dextromethorphan, hydrobromide, and quinidine sulfate) to treat PBA. Nuedexta can help reduce the number and intensity of crying and laughing episodes.

6. Find a support system

Many associations — both online and in person — offer support for caregivers. A caregiver support group can help you feel less alone.

Depending on your loved one’s condition, you might try reaching out to one of these organizations:

Your loved one’s doctor might also recommend support groups or peer mentors.

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Medical Reviewer: Heidi Moawad, M.D.
Last Review Date: 2023 May 3
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.