Diagnosis

Pseudobulbar affect is typically diagnosed during a neurological exam. Your care team checks how well the brain, spinal cord and nerves are working. You generally begin with a detailed medical history and if necessary, you have imaging tests such as a CT scan or an MRI. Specialists who can diagnose PBA include internists, neuropsychologists, neurologists and psychiatrists.

Pseudobulbar affect is often misdiagnosed as depression, bipolar disorder, generalized anxiety disorder, schizophrenia, personality disorder or epilepsy. To help your healthcare professional determine whether you have PBA, share specific details about when you laugh and cry unexpectedly and how you feel.

Treatment

The goal of treatment for pseudobulbar affect is to reduce how strongly and how often you have an emotional reaction you don't expect. There are medicines and techniques to help you manage your show of emotions. Your care team can help you choose the best treatment for you.

Medicines may include:

  • Dextromethorphan hydrobromide-quinidine sulfate (Nuedexta). This combination medicine works to block some receptors and activate others in the brain. Receptors are proteins on the surface of cells that receive messages from areas throughout the body. Nuedexta is the only medicine approved by the U.S. Food and Drug Administration to treat pseudobulbar affect.
  • Antidepressants. Medicines used to treat depression also may be used to treat pseudobulbar affect symptoms. Antidepressants such as tricyclic antidepressants, also called TCAs, and selective serotonin reuptake inhibitors, also called SSRIs, may help reduce PBA episodes. These medicines help balance chemicals in the brain, such as dopamine, epinephrine and norepinephrine. These chemicals are called neurotransmitters. They send signals between nerve cells.

Treatment also includes different techniques and therapies that may help manage your symptoms:

  • Identifying what triggers your reactions.
  • Distracting yourself before they happen.
  • Relaxing if you have a sudden emotional reaction.

Therapy may include mindfulness-based therapy, breathing exercises and meditation, which may help you manage your emotions.

It is important your care team recognize and diagnose pseudobulbar affect so that the right medicines and treatments are used to manage the condition. Education and treatment can help to manage symptoms and improve your quality of life. Ask your healthcare professional about PBA.

Coping and support

Knowing that pseudobulbar affect is a neurological condition, not a mental health issue, may help you better understand what is happening with your emotions. But living with pseudobulbar affect may, at times, still make you feel embarrassed or stressed. 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 with 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 write down details about your emotional reactions. Was the reaction voluntary? How long did it last? Was it true to how you were feeling? Was there a trigger for your reaction? Do these reactions you cannot control cause problems in your social interactions?
  • Prepare important information. Be ready to discuss any major stresses or recent life changes with your care team. Also, create a list of all medicines, vitamins, herbs and supplements that you are taking. If you have any past exams or formal testing results, bring them with you.

What to expect from your doctor

These are some of the questions your healthcare professional may ask you:

  • Do you cry easily?
  • Do you laugh at things that aren't really funny?
  • Does laughter often turn to tears?
  • Are you able to manage your crying or laughter?
  • Is it hard to stop your emotional response?
  • Do you have emotional responses that are not how you really feel or that are more than you would typically have?
  • Do your emotional reactions reflect what you're feeling at the time?
  • Do you avoid spending time with others because you're worried you'll laugh or cry at the wrong time?
  • Do you have any signs or symptoms of depression or other mood disorders?
By Mayo Clinic Staff