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Pseudobulbar Affect: Just Another Name for Depression?

Pseudobulbar affect (PBA) is a little-known neurological disorder that causes uncontrollable bouts of emotion such as laughing and crying.

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

Symptoms

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

Outbursts can include laughing, crying, and can last as long as a few minutes, or be as short as a few seconds. According to the American Stroke Association, these episodes can strike a person up to 100 times a day.

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.

Outbursts may also be overly exaggerated, for instance a person may exhibit a bout of raucous laughter in response to a neutral or mildly humorous situation.

Causes

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 can give rise to PBA include:

  • A stroke
  • Multiple Sclerosis
  • Alzheimer's disease
  • Parkinson's disease
  • Brain trauma
  • Lou Gehrig's disease (ALS)

Diagnosis

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. There is also a lack of awareness of PBA among medical professionals.

Current diagnostic methods for 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 tests are designed to help a physician determine how often and severe PBA outbursts are in a person and what their primary triggers are.

If you feel that you're caring for someone who may have undiagnosed PBA it's important to notify their doctor of your concerns so they can be formally diagnosed and treated.

Signs your loved one may be suffering from PBA:

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

Treatment

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, earlier this year, 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.

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.

That being said, a person can have both PBA and depression, but they are two separate diagnoses.

Prevalence

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 a Loved One's PBA

PBA can have an enormous impact on a person's social life. Emotional episodes caused by the disease can be embarrassing and can 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. The disease was also the cited culprit in being housebound for 40% of people in the survey.

For caregivers of people with PBA, it can be difficult trying to deal with a person who feels isolated and alone because of their disease.

PBAinfo.org offers a few tips for caregivers to help them interact positively with emotionally explosive loved ones:

  1. Let them know that you support them and they are not alone. Reassure them that many people suffer from the symptoms of PBA.
  2. Remind them that their outbursts are caused by a physical disease, not a mental condition.
  3. Indicate your willingness to listen to their frustrations and concerns.
  4. 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.
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