Pseudobulbar affect (PBA) is typically diagnosed during a neurological evaluation. Specialists who can diagnose PBA include internists, neuropsychologists, neurologists and psychiatrists.

PBA is often misdiagnosed as depression, bipolar disorder, generalized anxiety disorder, schizophrenia, a personality disorder and epilepsy. To help your doctor determine if you have PBA, share specific details about your emotional outbursts.


The goal of treatment for pseudobulbar affect (PBA) is to reduce the severity and frequency of emotional outbursts. Medication options include:

  • Antidepressants. Antidepressants, such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), can help reduce the frequency and severity of your PBA episodes. Antidepressants for the treatment of PBA are typically prescribed at doses lower than are those used to treat depression.
  • Dextromethorphan hydrobromide and quinidine sulfate (Nuedexta). This is the only medication approved by the Food and Drug Administration that is designed to specifically treat PBA. A study on people with MS and ALS showed that those taking the medication had only about half as many laughing and crying episodes as did those taking the placebo.

Your doctor will help you choose the best therapy for you, taking into account possible medication side effects and any other conditions you have and medications you use.

An occupational therapist also can help you develop ways to complete everyday tasks despite your PBA.

Coping and support

Living with psedobulbar affect (PBA) can be embarrassing and stressful. It might help to explain to family, friends and co-workers how the condition affects you, so they aren't surprised or confused by your behavior.

Talking to other people who have PBA also might help you feel understood and give you a chance to discuss tips for coping with the condition.

To cope with an episode:

  • Distract yourself
  • Take slow, deep breaths
  • Relax your body
  • Change your position

Preparing for your appointment

What you can do

  • Keep a symptom diary. Use a notebook to jot down details about your emotional outbursts. Was the outburst voluntary? How long did it last? Was it inappropriate? Was there a trigger for your outburst? Did your outburst reflect your emotions at the time? Do the outbursts cause problems in your social interactions?
  • Prepare key information. Be prepared to discuss any major stresses or recent life changes. Also, create a list of all medications, vitamins, herbs and supplements that you are taking. Bring any past evaluations and results of formal testing with you, if you have them.

What to expect from your doctor

Be ready to answer questions your doctor might ask, including:

  • Do you cry easily?
  • Do you become amused easily or laugh at things that aren't really funny?
  • Does laughter often turn to tears?
  • Are you able to control your crying or laughter? Do you have difficulty suppressing emotional reactions?
  • Do you experience emotional responses that are sometimes exaggerated or inappropriate?
  • Do your emotional outbursts reflect what you're feeling at the time?
  • Do you avoid spending time with others because you're worried that you'll have an emotional outburst?
  • Do you have any signs or symptoms of depression or other mood disorders?
May 16, 2018
  1. Mack E, et al. Information/education page: Pseudobulbar affect. Archives of Physical Medicine and Rehabilitation. 2014;95:1599.
  2. Brooks BR, et al. PRISM: A novel research tool to assess the prevalence of pseudobulbar affect symptoms across neurological conditions. PLOS One. 2013;8:e72232.
  3. Ahmed A, et al. Pseudobulbar affect: Prevalence and management. Therapeutics and Clinical Risk Management. 2013;9:483.
  4. Engleman W, et al. Diagnosing pseudobulbar affect in traumatic brain injury. Neuropsychiatric Disease and Treatment. 2014;10:1903.
  5. Galvez-Jimenez N. Symptom-based management of amyotrophic lateral sclerosis. http://www.uptodate.com/home. Accessed Feb. 29, 2016.
  6. National Stroke Association. Pseudobulbar affect — PBA. http://www.stroke.org/we-can-help/survivors/stroke-recovery/post-stroke-conditions/emotional/pba. Accessed March 1, 2016.


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