Pseudobulbar Affect Treatment: How to Choose the Right Path for You

If you struggle with uncontrollable emotional outbursts after stroke, you may have a condition known as pseudobulbar affect.

This condition causes extreme emotional reactions that are oftentimes inappropriate to the situation or context. For example, you might start sobbing uncontrollably when you are only mildly sad about something, or laughing at situations that are not necessarily funny.

Today you will learn the various treatments available for pseudobulbar affect. Different people will react differently to treatment, so it’s important to understand all your treatment options before you begin.

Cause of Pseudobulbar Affect

Pseudobulbar affect (PBA), also known as emotional lability, occurs after damage to areas of the brain that regulate emotions.

While scientists are still divided regarding which areas of the brain control emotion, the limbic system is thought to be in charge. This includes the hypothalamus, hippocampus, amygdala, and limbic cortex.

If a stroke impacts any of these areas, it may result in emotional disturbances like pseudobulbar affect.

However, it’s important to know that every stroke is different and every brain is wired a bit differently. This means that pseudobulbar affect is not limited to strokes within the limbic system.

All patients should still ask about the location of their stroke, because this information can help doctors provide a better diagnosis.

Now that you understand the cause of PBA, let’s discuss the symptoms and treatment methods.

Symptoms of Pseudobulbar Affect

The hallmark symptom of pseudobulbar affect includes random, uncontrollable emotional outbursts such as laughter or crying.

Typically, these emotions are exaggerated responses to something the person already feels. Sometimes, however, the emotions might not reflect the person’s true feelings.

For example, a stroke survivor with PBA might find themselves laughing hysterically at a normal situation. Or they might start sobbing even when they aren’t unhappy.

Uncontrollable emotional outbursts can be troubling for both the person afflicted with pseudobulbar affect and the people they are with. Fortunately, there are ways to treat pseudobulbar affect after stroke.

Important: Avoid Misdiagnosis for Pseudobulbar Affect Treatment

The most common treatments for pseudobulbar affect include medication and psychotherapy.

However, because of the way this condition affects emotional expression, doctors often mislabel it as post-stroke depression, or some other mood disorder. But it is critical to get an accurate diagnosis for PBA because treatment can differ.

To help your doctor find the right treatment for you, try to be as specific as you can about your symptoms.

For example, one of the key differences between pseudobulbar affect and depression is that PBA causes outbursts of crying or laughter for no apparent reason. In addition, these outbursts tend to last only a short time and may occur several times in a day.

Therefore, do not simply tell your doctor that you cry or laugh more after your stroke. Be specific and tell them that there is often no reason for your emotional outbursts. This will help your doctor give you an accurate diagnosis.

Once you get the right diagnosis, you can begin trying different treatments.

Medical Treatments for Pseudobulbar Affect

Perhaps the most effective way to manage pseudobulbar affect is through medication.

The primary treatment for pseudobulbar affect includes antidepressants. Some of the most effective antidepressants for reducing pseudobulbar affect include:

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Citalopram (Cilexa)

Several studies have shown that these antidepressants reduce laughing and weeping episodes more than a placebo.

While antidepressants can help, the FDA has not approved them to treat pseudobulbar affect. Fortunately, the FDA has approved a medication designed specifically to treat PBA, called Nuedexta.

Studies have found that patients who used it had half as many emotional outbursts as those who used a placebo. Improvement in symptoms usually occurs within the first week of treatment.

Other Theories for Pseudobulbar Affect Treatment

While medication is the only scientifically verified way to treat PBA, many stroke patients have found success using natural alternatives. For example, some psychologists recommend a therapy known as emotional practice.

Emotional practice is a cognitive-behavioral technique that seeks to rewire the brain to control emotions again. You will do this by practicing feeling the appropriate emotions given the contextual situation.

For example, when watching a funny film, try telling yourself “I feel happy watching this.” Even if you don’t actually feel anything yet, the goal is to make a connection in your brain between your emotions and the activity.

This idea is that, with enough practice, your brain can begin to respond correctly to emotional situations.

We want to emphasize that this method is still relatively new, and has not been clinically tested like other treatments for pseudobulbar affect. Medication is still considered the most effective treatment.

But if you are looking to avoid taking more medications, emotional practice may be worth trying.

Understanding and Treating Pseudobulbar Affect After Stroke

Pseudobulbar affect after stroke causes extreme emotional outbursts. This can make it more difficult to take part in activities you enjoy.

However, there is still hope. Medications such as Nuedexta can help you regain control over your emotions again. And natural alternatives such as emotional practice may also lessen the severity of your symptoms.

For more detailed information on dealing with the emotional effects of stroke, check out our book Healing & Happiness After Stroke.