After experiencing a traumatic brain injury (TBI), some people begin to spontaneously laugh or cry for no reason. This unexpected, uncontrollable laughing or crying is called pseudobulbar affect (PBA) or emotional incontinence.
The episodes can last for a few seconds or several minutes. Because the laughing or crying can be explosive and uncontrollable — and it can come out of nowhere — people often become embarrassed and frustrated with themselves, even though it’s not intentional. But there are treatments that can help.
Here’s what you need to know if you or someone you love develops this condition after experiencing a traumatic brain injury.
An underrecognized problem
Pseudobulbar affect can occur in people with a traumatic brain injury or other neurological disorders, such as Alzheimer’s disease, brain tumors, stroke, Parkinson’s disease, multiple sclerosis, or amyotrophic lateral sclerosis.
Although the exact cause is unknown, PBA develops when the cerebellum can’t communicate as well with the cerebral cortex to control emotional responses due to injury or some neurological damage.
PBA is common in people with a neurological disorder or injury, including traumatic brain injury. However, 2020 research says PBA often goes unrecognized — or under-recognized.
It’s easy to confuse the symptoms like crying with symptoms of a mood disorder like depression or bipolar disorder. As a result, PBA often gets misdiagnosed as a mood disorder or other issue.
Because it is often misdiagnosed, it’s unknown how many people with TBI who develop PBA. Some older statistics give a wide range when it comes to estimating the percentage of people with TBI who live with this condition: 5-48%.
If you notice involuntary or unexpected crying and laughing fits, don’t dismiss them. Discuss your concerns with a doctor.
Currently, there is no cure for PBA. However, treatment may help manage the symptoms.
Doctors can prescribe a combination of medicines approved by the Food and Drug Administration (FDA) to treat pseudobulbar affect. Known by the brand name Nuedexta, the treatment is a combination of dextromethorphan, which you may recognize from packages of cough suppressant medication, and a low dose of quinidine sulfate.
Sometimes, doctors will also suggest a low dose of an antidepressant to help manage the symptoms. For example, you may consider a selective serotonin reuptake inhibitor (SSRI) like citalopram (Celexa) or even an older type of antidepressant, a tricyclic antidepressant like amitriptyline (Elavil) off label.
However, it’s important to manage your expectations. The American Stroke Association cautions that PBA is not depression, and this type of treatment may or may not help.
Ultimately, it’s essential to communicate with your loved one’s doctor so you can have a conversation about the best way to proceed.