Pseudobulbar affect (PBA)

Diagnosis

Diagnosing pseudobulbar affect (PBA) poses significant challenges for healthcare professionals due to its symptomatic similarities with various mood disorders, such as depression, bipolar disorder, generalized anxiety disorder, schizophrenia, a personality disorder, or epilepsy, especially in the absence of a definitive test. The diagnosis typically hinges on a comprehensive neurological assessment, which includes a deep dive into the patient’s symptoms, medical and mental health histories, and physical examination findings. Specialists capable of diagnosing PBA include internists, neuropsychologists, neurologists, and psychiatrists. Patients play a crucial role in the diagnostic process by providing detailed descriptions of their emotional outbursts, thereby assisting their doctors in distinguishing PBA from other conditions.

Treatment

Reducing the intensity and frequency of emotional outbursts is the primary objective of treatment for pseudobulbar affect (PBA). Options for medication include:

• Antidepressants: Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are two antidepressants that can help lessen the frequency and intensity of your PBA episodes. Usually, lesser dosages of antidepressants are given for PBA treatment than for depression treatment.
• Dextromethorphan hydrobromide and quinidine sulfate: This is the only drug that has been approved by the FDA and is intended to treat PBA exclusively. In an MS and ALS trial, the number of laughing and crying episodes was roughly half for those on the medicine and nearly half for those on a placebo.

Along with considering any adverse reactions to medications and any additional conditions you may have, your healthcare provider will work with you to determine the best course of action.

You can also work with an occupational therapist to find strategies for doing daily tasks despite of your PBA.