Find a Doctor Find a Doctor
Time to see a specialist?
Time to see a specialist?
We found [COUNT] Specialists
who treat [INTEREST]
near [LOCATION]
We found [COUNT] Specialists
who treat [INTEREST]
near [LOCATION]
[TELEHEALTH] offer Telehealth options.
More
Treating Involuntary Crying and Laughing

This content is created by Healthgrades and brought to you by an advertising sponsor. More

This content is created or selected by the Healthgrades editorial team and is funded by an advertising sponsor. The content is subject to the Healthgrades medical review process for accuracy, balance and objectivity. The content is not edited or otherwise influenced by the advertisers appearing on this page except with the possible suggestion of the broad topic area. For more information, read the Healthgrades advertising policy.

Pseudobulbar Affect: A Guide to Definition and Causes

Medically Reviewed By Susan W. Lee, DO

Pseudobulbar affect (PBA) refers to brief, uncontrollable episodes of laughing, crying, or both. PBA is associated with various neurological conditions, such as traumatic brain injury, Alzheimer’s disease, and stroke. While there is currently no cure for PBA, medications like antidepressants may help prevent or reduce the severity of PBA episodes.

This article discusses pseudobulbar affect and its causes, diagnosis, and management.

What is pseudobulbar affect?

A woman with her hand on the shoulder of a man who is laughing while crying
Design by Wenzdai Figueroa; Photography by Klaus Vedfelt/Getty Images

PBA causes involuntary episodes of laughing, crying, or a mixture of both. Some people may also experience Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source anger or aggressive behavior.

According to the American Stroke Association (ASA) Trusted Source American Stroke Association Highly respected international organization Go to source , PBA episodes have three characteristic features:

  • They are brief, lasting only seconds to minutes.
  • They are involuntary, meaning the person experiencing an episode is unable to control it.
  • They appear similar across individuals, meaning the episodes have shared characteristics regardless of the underlying cause.

These episodes can appear out of proportion to the situation. For example, a person may be in a mildly sad situation, but they may experience severe and uncontrollable sobbing. Alternatively, there may be no apparent emotional trigger that precedes an episode.

What causes pseudobulbar affect?

The ASA states Trusted Source American Stroke Association Highly respected international organization Go to source that PBA occurs when there is a disconnect between the frontal lobe, brain stem, and cerebellum.

The frontal lobe is a part of the brain involved in functions like memory, voluntary movement, emotions, and executive function. The brainstem and cerebellum control motor function and coordination.

PBA is associated with various neurological conditions, such as:

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

How do doctors diagnose pseudobulbar affect?

Doctors may be able to diagnose PBA during a neurological evaluation. They may ask questions about your symptoms and medical history, or they may use a formal scale like the Center for Neurologic Study – Lability Scale (CNS-LS). This is a questionnaire that helps doctors assess PBA episode frequency and severity.

The Pathological Laughing and Crying Scale (PLACS) may also Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source be a helpful tool for diagnosing PBA. Like the CNS-LS, this is a questionnaire with various questions to determine PBA episode severity.

If your doctors suspect PBA, they may also run additional tests to determine the underlying cause, such as imaging tests.

What are the treatments for pseudobulbar affect?

There is currently no cure for PBA. However, certain medications may help prevent Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source some episodes or reduce their severity. These medications include selective serotonin reductase inhibitors (SSRIs) and tricyclic antidepressants (TCAs).

Most medications used for PBA are prescribed off-label, meaning they haven’t specifically been approved for treating PBA. However, in 2010, the Food and Drug Administration (FDA) approved Nuedexta, which contains dextromethorphan hydrobromide and quinidine sulfate. This medication can treat PBA without first identifying an underlying cause.

In addition to medications, the ASA states that specific coping techniques Trusted Source American Stroke Association Highly respected international organization Go to source may help prevent or relieve an episode. For example, if you can feel an episode coming on, it may be beneficial to distract yourself by thinking about something unrelated to the episode. Taking deep breaths and trying to relax your muscles may also help.

What is the outlook for people with pseudobulbar affect?

PBA can have adverse effects on quality of life. It may be disruptive to your daily activities and increase stress. However, following your doctor’s treatment plan as closely as possible may help manage the condition and increase your ability to maintain your typical routine.

Is pseudobulbar affect a mental illness?

Pseudobulbar affect is classified Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source as a neurological impairment, not a mental illness. It may be mistaken for depression, but there are some key differences.

Depression can also cause bouts of crying, but unlike PBA, these are typically related to your situation and how you feel. Depression symptoms can also last Trusted Source National Institute of Neurological Disorders and Stroke Governmental authority Go to source for long periods, whereas PBA episodes generally last seconds to minutes.

In addition, PBA is associated with an underlying condition like ALS or TBI. People with depression may or may not have an underlying condition.

Learn 7 things doctors want you to know about depression.

Other frequently asked questions

Susan W. Lee, D.O., reviewed the answers to these common questions about PBA.

Does pseudobulbar affect get worse?

The severity of PBA may get better or worse over time, depending on the underlying cause and how well medications can manage the episodes. People with progressive conditions like Alzheimer’s may find that their PBA symptoms worsen over time.

How do you fix PBA?

There is currently no known way to fix PBA permanently. However, medications like antidepressants or Nuedexta may relieve your symptoms.

Summary

PBA is generally characterized by brief episodes of laughter, crying, or both that a person cannot control. It often occurs alongside ALS, Alzheimer’s disease, and stroke.

Doctors may be able to diagnose PBA with a neurological evaluation or formal scales like the CNS-LS and PLACS. They may also need to perform additional tests to determine the underlying cause.

Treatment for PBA typically consists of medications like SSRIs, TCAs, or dextromethorphan/quinidine.

Talk with your doctor about ways to manage PBA.

Was this helpful?
26
  1. Ahmed, A., et al. (2013). Pseudobulbar affect: Prevalence and management. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849173/
  2. Chen, J. J., et al. (2017). Pharmacotherapeutic management of pseudobulbar affect. https://www.ajmc.com/view/pharmacotherapeutic-management-of-pseudobulbar-affect
  3. Depression. (2023). https://www.nimh.nih.gov/health/topics/depression
  4. Espiridion, E. D., et al. (2020). Pseudobulbar affect presenting as hypomania. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164551/
  5. Kazi, S. E., et al. (2022). Pseudobulbar affect presenting as aggressive behavior. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8906197/
  6. Nuedexta (dextromethorphan hydrobromide and quinidine sulfate). (2010). https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021879s000lbl.pdf
  7. Pseudobulbar affect (PBA). (2018). https://www.stroke.org/en/about-stroke/effects-of-stroke/emotional-effects-of-stroke/pseudobulbar-affect
  8. Tu, S., et al. (2021). Brainstem correlates of pathological laughter and crying frequency in ALS. https://www.frontiersin.org/articles/10.3389/fneur.2021.704059/full

Medical Reviewer: Susan W. Lee, DO
Last Review Date: 2023 May 18
View All Treating Involuntary Crying and Laughing Articles
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.