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Treating Involuntary Crying and Laughing

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Managing Involuntary Laughing and Crying After Stroke

Medically Reviewed By Susan W. Lee, DO

Known as the pseudobulbar affect (PBA), episodes of involuntary and uncontrollable crying or laughing can be a common complication in the first few weeks and months after having a stroke. Though there is currently no cure, medications can help reduce symptoms.


PBA is not a widely known condition, but ongoing research is helping doctors better understand PBA and improve treatment options.

What is the pseusobulbar affect?

PBA is a neurological condition that may affect a person who had a stroke. It also can affect people with the following conditions:

  • Alzheimer’s disease
  • multiple sclerosis
  • Parkinson’s disease
  • traumatic brain injury

An estimated 1 in 5 Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source  people who have had a stroke experience PBA in the initial acute and post-acute phases of stroke recovery. By 6 months, about 1 in 8 people still experience episodes of laughing, crying, or both.

A stroke can lead to PBA by causing damage to the pathways between the frontal lobe and the cerebellum and brain stem.

PBA episodes usually last a few seconds or minutes. They may be appropriate to the circumstances, such as crying while watching a sad movie or laughing during a happy celebration.

However, the involuntary laughter or tears may also occur without a specific cause.

Diagnosing PBA

To manage PBA, an accurate diagnosis is essential. The condition is often misdiagnosed because PBA symptoms, particularly crying episodes, often mirror signs of depression — another common complication of stroke Trusted Source American Stroke Association Highly respected international organization Go to source .

Many people with PBA may be reluctant to tell their doctor about their symptoms due to embarrassment or because they believe the episodes are simply emotional responses after recovering from a stroke.

To help your doctor reach an accurate diagnosis, you can provide details about your medical history and the frequency and duration of your crying or laughing episodes. It’s also important to explain the situations in which the episodes occur — involuntary laughter or crying during inappropriate settings can help confirm a diagnosis of PBA.

Treating PBA

For a long time, doctors treated PBA with various antidepressants. These medications are still prescribed today, though often with limited or inconsistent benefits.

However, in 2020, the Food and Drug Administration (FDA) approved the first drug exclusively made to treat PBA: dextromethorphan HBr and quinidine sulfate (Nuedexta).

The medication is from a class of drugs called N-methyl-D-aspartate (NMDA) receptor antagonists, typically used to treat Alzheimer’s disease, Parkinson’s disease, pain, and depression. Keep in mind that PBA, like Alzheimer’s, is a neurological condition and not an emotional or psychological disorder.

Research from 2020 suggests that dextromethorphan HBr and quinidine sulfate can reduce or even eliminate PBA symptoms in some cases.

If PBA episodes stop altogether or become so infrequent or minor that they no longer affect your daily functioning or quality of life, you and your doctor can decide whether to continue taking the medication. Stopping the medication may or may not lead to a recurrence of PBA episodes.

Lifestyle and behavioral changes

Managing PBA can also involve various behavioral strategies. When you feel a PBA episode coming on, try to distract yourself by counting items in a room or concentrating on something unrelated to what’s happening around you.

Try taking a few deep breaths and relaxing your shoulders and other muscle groups. You may also be able to short-circuit an episode by changing your body position as you feel an episode developing.

A 2020 study suggests that these self-care strategies can be effective in many situations.


Understanding PBA symptoms is essential to finding the correct treatment. Working with your doctor is the first step to learning how to manage symptoms.

You might find additional support from others by telling them about your PBA and explaining that the episodes are out of your control. Friends and family members may be able to help you find relaxation and distraction strategies to improve your quality of life.

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Medical Reviewer: Susan W. Lee, DO
Last Review Date: 2023 May 3
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