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Treating Involuntary Crying and Laughing

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Multiple Sclerosis and Uncontrolled Laughing or Crying

Medically Reviewed By Heidi Moawad, M.D.

People living with multiple sclerosis (MS) may experience involuntary episodes of laughing or crying, known as pseudobulbar affect disorder (PBA). Symptoms can be treated with medication and behavioral strategies to reduce the frequency of episodes and improve quality of life.


Some of the most common symptoms of MS include muscle spasms or stiffness, fatigue, and balance problems. However, for some people with MS, a less-known set of symptoms includes brief but uncontrolled laughing or crying episodes.

An estimated 1 out of 10 people with MS experience PBA, though the actual number may be higher. PBA symptoms often overlap with depression and other emotional or psychological conditions, making diagnosing it challenging.

What is the pseudobulbar affect?

The exact cause of PBA is not fully understood. The condition may result from damage to regions of the brain responsible for emotional control. The injury may interfere with how \signals related to emotions are transmitted between brain cells.

Episodes of laughing or crying can last a few seconds or several minutes and occur without warning or in any circumstances. Laughter or tears may be unrelated to your mood.

For example, a sudden burst of tears may erupt during a festive dinner celebration. As a result, people with PBA may feel symptoms can interfere with work and relationships. Although these emotional expressions can’t be managed while experiencing an episode, treatment can sometimes reduce the frequency and improve your quality of life.

How is PBA diagnosed and treated?

The National Multiple Sclerosis Society says PBA is underdiagnosed and undertreated, partly because people with MS often don’t talk about PBA symptoms with their doctors.

People may be unaware that these laughing and crying episodes are directly related to their MS. The condition is also frequently unrecognized because symptoms, such as uncontrolled crying, are often viewed as signs of depression and are treated with antidepressants.

To make an accurate diagnosis, your doctor may conduct medical, neurological, and psychological assessments and review the history and nature of your crying or laughing episodes. It’s essential to describe the episodes in as much detail as possible. This can help your doctor distinguish PBA from depression.

Even though they are two separate conditions, PBA and depression Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source can and often occur together. Higher levels of stress and anxiety also often accompany PBA.

Two screening tools are helpful in making a formal PBA diagnosis. One is the Center for Neurologic Study-Lability Scale (CNS-LS), a test with seven questions. These cover how long laughing or crying episodes last, how often you have them, and how often they occur.

A similar test, the Pathological Laughter and Crying Scale (PLACS), is administered by a healthcare professional. PLACS includes 18 questions about the duration and intensity of episodes and how much distress you feel after an episode ends.

Doctors often prescribe antidepressants to treat PBA, though these medications often have little impact. The Federal Drug Administration (FDA) has approved dextromethorphan, hydrobromide, and quinidine sulfate (Neudexta), which remains the only drug specifically approved for PBA treatment.

However, PBA treatment remains an active area of research, suggesting that additional therapies may be on the way.

Living with PBA

There is no cure for PBA. However, some behavioral strategies may help reduce the severity and duration of PBA episodes. You may find relief by distracting yourself. Count items around you or think about an unrelated subject. Taking deep breaths and relaxing your shoulders and other muscles may shorten the length of a crying or laughing episode.

As you work with your doctor to find the correct treatment, you could contact a mental health professional to help you navigate stress or anxiety from a PBA diagnosis.

Be open with your family, friends, co-workers, and others. Explain PBA symptoms so they are not surprised when an episode occurs and understand that this is simply one more aspect of MS.

If you experience episodes of uncontrolled laughing or crying, talk with your doctor about the possibility that you may have PBA.

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Medical Reviewer: Heidi Moawad, M.D.
Last Review Date: 2023 Apr 25
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