Pseudobulbar Affect (PBA)

Pseudobulbar affect (PBA) is a condition that occurs due to other neurological conditions and may occur in patients with amyotrophic lateral sclerosis (ALS or Lou Gehrig’s Disease), Parkinson’s disease, multiple sclerosis (MS), multiple system atrophy, and progressive supranuclear palsy. Traumatic brain injury via accident or stroke may also cause PBA to appear.

The main symptom of this condition is sudden, unexplained and unstoppable laughing, crying or bouts of anger that can occur multiple times a day for no apparent reason. Although episodes of laughing or crying may seem appropriate for the triggering event, they tend to be more difficult to restrain and can be more intense and last longer than would ordinarily be expected. However, they can also be relatively minor and subtle, such as getting choked up or a brief giggle.

Due to this, PBA is often confused as a mental illness. However, this neurological impairment can cause depression, as well as lead to other symptoms associated with both depression and bipolar illness, as the psychological consequences and impact on social interactions may be substantial and cause embarrassment and anxiety, leading to withdrawal and social isolation.

How common is PBA?

It is estimated that between 1 and 7 million people in the United States have PBA depending on the severity of symptoms, with the lower number representing individuals with more severe symptoms.

While there is no cure for PBA, oral medications are used to reduce the frequency and severity of episodes. Antidepressants have been utilized to aid in managing symptoms but have proved to only be moderately successful. To combat this, a drug called Neudexta (a combination of a cough suppressant and a very low dose of quinidine sulfate, a drug used in the past to treat cardiac arrhythmias) was specifically developed to treat PBA. The drug was approved by the FDA in 2010 and has shown an improvement in symptoms that usually occurs within the first week of starting treatment and continues with no evidence of losing efficacy. However, more research is needed to determine whether the drug is safe for people with certain neurological disorders like Parkinson’s disease and if there are potential problems with mixing it with other medications needed for the management of illnesses associated with PBA.

Additionally, these coping techniques may help:

• Be open about the problem so people aren’t surprised or confused when you have an episode
• Distract yourself by counting the number of objects on a shelf or by thinking about something unrelated when you think you’re about to have an episode
• Take slow deep breaths until you’re in control
• Relax your forehead, shoulders and other muscle groups that tense up during an episode
• Change your body position. Note your posture when you’re having an episode. When you think you’re about to cry or laugh, change your position

The recent release of Joker has shone a spotlight on this broadly misunderstood disorder. If you think you may have PBA, talk to your doctor. If you have a neurological condition, you might already be treated by a doctor who can diagnose PBA. Helpful specialists include neuropsychologists, neurologists and psychiatrists.

Sources:

• Ahmed A, Simmons Z. Pseudobulbar affect: prevalence and management. Ther Clin Risk Manag. 2013;9:483–489. doi:10.2147/TCRM.S53906
• American Stroke Association. Pseudobulbar Affect (PBA). 2018.
• Cleveland Clinic. Pseudobulbar Affect (PBA): Management and Treatment. 2019.
• Grohol Psy.D., John. Pseudobulbar Affect. Psychcentral. 2019.
• Purse, Marcia. Differences Between Depression, Bipolarism and PBA. Very Well Mind. 2019.