The Little-Known Disorder that Mimics Depression, But Isn’t

Pseudobulbar affect (PBA) is a little-known neurological disorder that can cause uncontrollable outbreaks of emotion, such as laughing and crying.

Also known as “emotional incontinence,” PBA can strike a person at any age, but generally accompanies another neurological diseases, such as Multiple Sclerosis and Alzheimer’s, according to PBAinfo.org, a website dedicated to raising awareness about this little-known, and often misunderstood disorder.

Symptoms of PBA

Emotional outbursts that are sudden and uncontrollable represent the primary symptom of PBA.

These outpourings of emotion can run the gamut; from bouts of laughter, to episodes of crying that may last anywhere from a few seconds, to a few minutes. These episodes can strike up to 100 times a day, according to the American Stroke Association.

Besides being out of the control of the person experiencing them, the emotional spells caused by PBA may not reflect the actual feelings of that individual. A person may cry in response to a joke, or have a laughing fit during a funeral.

Surges of emotion may also be overly exaggerated. For instance, an individual may exhibit a bout of raucous laughter in response to a neutral or mildly humorous situation.

Causes of PBA

PBA is thought to be triggered by a traumatic injury, or a neurological disease that affects the parts of the brain that deal with the processing and expression of emotions. In effect, people with PBA suffer from an injury-induced, “short-circuiting” of the signals that govern their emotions.

Some health problems that may give rise to PBA include:

  • A stroke
  • Multiple Sclerosis
  • Alzheimer’s disease
  • Parkinsonís disease
  • Brain trauma
  • Lou Gehrig’s disease (ALS)

Diagnosing PBA

PBA is a separate neurological disorder that can be diagnosed and treated independently of other health problems. But diagnosis can often be tricky, as the symptoms of this disease closely mirror those of depression and other mood disorders. Many medical professionals donít even know that PBA is a distinct disorder.

Diagnostic methods for detecting PBA are relatively sparse. There are essentially two tests a doctor may use to identify a person with the PBA: the Pathological Laughter and Crying Scale and the Center for Neurologic Study-Lability Scale.

These screenings are designed to help a physician determine how often, and how severe, PBA outbursts are in patients, as well as what their primary emotional triggers are.

If you feel that you, or a loved one, might have undiagnosed PBA, it’s important to notify a doctor of your concerns so that a formal diagnosis can be made and a treatment plan drawn up.

Continue reading to learn more about the signs of PBA, and how to cope with the disorder…

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Pseudobulbar Affect: Just Another Name for Depression? originally†appeared on†AgingCare.com.

Signs that you may be suffering from PBA:

  • You have a neurological condition, such as Alzheimer’s, MS, or Parkinson’s, or have had a stroke
  • You cry or laugh for no reason, or at improper times
  • You can’t seem to control your laughter or crying

Treating PBA

In the past, PBA was primarily treated with off-label prescriptions for SSRIs, antidepressants, and Levodopa. These medications are sometimes helpful, but their usefulness is spotty, and their side effects undesirable.

But, a few years ago, the first-ever drug specifically designed to treat PBA was released. The medication, Neudexta, was found to safely cut down on the intensity and regularity of emotional outbursts in people with PBA.

Just another name for depression?

PBA is not synonymous with depression.

Depression is a psychiatric disorder caused by a chemical imbalance in the brain. People with depression constantly feel unhappy and the expression of their emotions remains consistent with how they are feeling.

PBA is a neurological disorder caused by brain damage. People with PBA may feel sad, but the manifestation of their sadness may be laughter because the disease is interfering with their process of emotional expression. An individual may have both PBA and depression, however they are two separate diagnoses.

Prevalence of PBA

In people with neurological diseases such as Alzheimer’s and MS, as well as those who suffer from strokes, PBA can be very prevalent.

Figures from the National Stroke Association indicate that 20% of stroke sufferers will experience PBA in the year following their stroke. And, a study conducted by the Brain Injury Association of America recently found that as many as 80% of people who suffer a traumatic brain injury have also exhibited signs of PBA.

Coping with the effects of PBA

PBA can have an enormous impact on a person’s social life. Emotional episodes caused by the disease can be embarrassing, and may damage interpersonal relationships.

The Brain Injury Association of America study indicates that 60% of people with brain injuries feel that PBA and its accompanying outbursts make it hard for them to initiate and maintain friendships.

Dealing with the feelings of isolation brought on by the effects of the disorder can be a challenge for people with PBA.

PBAinfo.org offers a few tips to help people living with PBA cope with the negative effects of the disease:

  • Bear in mind that your emotional outbursts are caused by a physical disease, not a mental condition.
  • Find people who are supportive and willing to listen to your frustrations and concerns.
  • Keep an “episode diary.” By recording PBA episodes, you can ensure better communication with your doctor and help him or her make an accurate diagnosis and treatment plan.

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By Anne-Marie Botek, AgingCare.com Editor

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106 comments

Kathy Perez
Kathy Johnson2 years ago

interesting comments. interesting article

Sheri P.
Sheri P.2 years ago

interesting! i've never heard of that before...

Past Member
Past Member 2 years ago

This is good information to have if you are caretaking someone who has survived a stroke or other possible brain trauma. Important to remember there can be a physical cause for emotional outbursts.

Carolanne Powell
Carolanne Powell2 years ago

Interesting...I am a psychiatric nurse but have never heard of this diagnosis. Thanks Care2 for the info.

Tammy B.
Tammy B.2 years ago

Someone else commented that Christians are brainwashed. If anyone is following any other than the True God, Jesus Christ, this may indeed be. If they are true Christians following Jesus they not only do not drink any blood, they are also horrified at the spilling of any blood. So Jane whoever you are please get your facts straight before you start to generalize Christians as haters. I am not about to be offended by a truly ignorant sort as yourself. Though I will insist you educate yourself for your own good. Have a great night!

Tammy B.
Tammy B.2 years ago

No Thank You!!! First of all I am sick of all of this nonsense of yet another disorder we all may have and or develop! No NO No!!! It's all BS to trick us into thinking we can none of us survive without yet ANOTHER prescription drug. And I don't buy it. What do you call RLS? A person just dosen't want to go to bed. Fine then get up and do something till you do want to go to bed! Common sense tells you that.But if you pop a pill for that man I feel sorry for you! Granted some of us come up from a life of pure hell. Enough to be depressed about. Is that enough of a reason to take a drug daily and claim the label Major Depessed? I for one survived the death of my child. And at one time had that diagnosis. Yes for a time I needed pills for it. Not forever though! Before you buy into this need for a or another pill ask yourself, How strong am I? You just might be surprised at the answer.Doctors don't know everything!

Dot A.
Dot A.2 years ago

Useful information~ Can't say the 'drug remedy' is always the best way to go, however. Our society is being handed a pill for every human reaction to living,... [and it usually isn't very pleasant for the drug taker to experience the mind altering affects] But, in some cases perhaps a mild medication could soften the symtoms. It seems the drug is primarily advised for those who share a life with the person's affliction, rather than the actual health benefits of the one who has this syndrome.

Still and yet, a good article.

Fred Hoekstra
Fred Hoekstra2 years ago

Thank you AgingCare, for Sharing this!

Pam W.
Pami W.2 years ago

PBA sounds like a very sad condition for those who suffer from it.

Arwen Woods
Arwen Woods2 years ago

Jane, have you any idea how addled you sound? Of course religion does not cause depression. A chemical imbalance in the brain causes depression my dear.