Materiały źródłowe

• #1 Pseudobulbar Affect (PBA): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17928-pseudobulbar-affect-pba

  Pseudobulbar affect (PBA) is a neurological condition that causes outbursts of uncontrolled or inappropriate laughing or crying. […] Its manageable with medication. […] Theres no cure for pseudobulbar affect (PBA), but certain medications can help manage it. The goal of treatment is to reduce the frequency and severity of episodes of laughing or crying. […] Medications that healthcare providers prescribe for PBA include: Dextromethorphan/quinidine sulfate (Nuedexta): The FDA has approved a combination of dextromethorphan (a cough suppressant) and a very low dose of quinidine sulfate (a drug used in the past to treat cardiac arrhythmias) as the first drug specifically developed to treat PBA. […] Antidepressants: Tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) and norepinephrine/serotonin reuptake inhibitors may help manage the symptoms of PBA. The doses are typically lower than the doses required to treat depression. […] Medication can help manage symptoms. It may be difficult to receive a diagnosis and treatment, but its important to continue to advocate for yourself.

• #2 Pharmacotherapeutic Management of Pseudobulbar Affect

  https://www.ajmc.com/view/pharmacotherapeutic-management-of-pseudobulbar-affect

  This activity will update pharmacists and other healthcare professionals on current treatments for pseudobulbar affect (PBA). […] PBA has also been referred to as emotionalism, emotional lability, or pathological crying and laughing, particularly when attributed to stroke or traumatic brain injury (TBI). […] Although PBA has been recognized in science and medicine for more than 100 years, it remains an underrecognized and undertreated condition that can be effectively treated with pharmacological methods. […] Current prevailing theories suggest that PBA occurs when neural pathways that modulate emotional responses in the brain are interrupted, particularly descending pathways from the brain (such as the frontal lobes) to the cerebellum through the basis pontis. […] Medical disorders or conditions, such as Parkinson disease (PD), multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Alzheimer disease (AD), TBI, and stroke, which result in a disruption of those pathways, can produce the hallmark symptoms of PBAinvoluntary and uncontrollable laughter and/or crying.

• #3 Pharmacotherapeutic Management of Pseudobulbar Affect

  https://www.ajmc.com/view/pharmacotherapeutic-management-of-pseudobulbar-affect

  This activity will update pharmacists and other healthcare professionals on current treatments for pseudobulbar affect (PBA). […] PBA has also been referred to as emotionalism, emotional lability, or pathological crying and laughing, particularly when attributed to stroke or traumatic brain injury (TBI). […] Although PBA has been recognized in science and medicine for more than 100 years, it remains an underrecognized and undertreated condition that can be effectively treated with pharmacological methods. […] Current prevailing theories suggest that PBA occurs when neural pathways that modulate emotional responses in the brain are interrupted, particularly descending pathways from the brain (such as the frontal lobes) to the cerebellum through the basis pontis. […] Medical disorders or conditions, such as Parkinson disease (PD), multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Alzheimer disease (AD), TBI, and stroke, which result in a disruption of those pathways, can produce the hallmark symptoms of PBAinvoluntary and uncontrollable laughter and/or crying.

• #4 Pseudobulbar affect – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudobulbar-affect/diagnosis-treatment/drc-20353741

  PBA is often misdiagnosed as depression, bipolar disorder, generalized anxiety disorder, schizophrenia, a personality disorder and epilepsy. […] The goal of treatment for pseudobulbar affect (PBA) is to reduce the severity and frequency of emotional outbursts. Medication options include: […] Antidepressants, such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), can help reduce the frequency and severity of your PBA episodes. […] Dextromethorphan hydrobromide and quinidine sulfate (Nuedexta). This is the only medication approved by the Food and Drug Administration that is designed to specifically treat PBA. […] Your doctor will help you choose the best therapy for you, taking into account possible medication side effects and any other conditions you have and medications you use. […] An occupational therapist also can help you develop ways to complete everyday tasks despite your PBA.

• #5 Pseudobulbar affect: prevalence and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3849173/

  The goal of treatment of PBA is to diminish the severity and frequency of episodes. […] The serotonergic action of SSRIs and TCAs appears to be the most significant therapeutic mechanism in treatment of PBA, via an increase in availability of serotonin at the synapses in corticolimbic and cerebellar pathways. […] In contrast to SSRIs and TCAs, dextromethorphan inhibits glutamatergic neurotransmission via actions at a variety of locations including N-methyl-D-aspartate receptors and -1 receptors. […] Until recently, all treatments have, of necessity, been off-label. […] The efficacy of antidepressants appears to be unrelated to the treatment of depression, based upon several pieces of evidence: 1) the onset of action may occur within a few days, which is faster than expected for depression; 2) doses are lower than those usually used to treat depression; and 3) most patients with PBA are not depressed.

• #6 Treatment for Pseudobulbar Affect

  https://resources.healthgrades.com/right-care/brain-and-nerves/understanding-treatment-options-for-pseudobulbar-affect

  Understanding Treatment Options for Pseudobulbar Affect […] Managing the symptoms of pseudobulbar affect (PBA) can be unsettling. Getting the correct diagnosis can take some time because the symptoms occur with other conditions. However, once you do, treatment can help manage symptoms. […] […] When treating any disease or disorder, it is important to consider your goals. The treatment goals for PBA include reducing the frequency and severity of emotional outbursts. Achieving this goal often fulfills other goals, such as improving your quality of life. […] There are two main ways to accomplish PBA treatment goals — behavioral therapy and medications. Combining the two usually offers the best chance of reaching the treatment goal. […] […] Learning and understanding triggers through behavioral therapy can help people with PBA avoid specific social scenarios and manage symptoms. […]

• #7 Pseudobulbar Affect Treatment: Managing Emotional Outbursts

  https://www.flintrehab.com/pseudobulbar-affect-treatment/?srsltid=AfmBOoo_FoAz7IR7KcQxaaC-Kly2JbfWzEjMZHjEwROz8SWbKy4NJX36

  Uncontrollable emotional outbursts are common after stroke and are often attributed to a condition known as pseudobulbar affect. […] Thankfully, there are some options available to survivors to help address this secondary effect. […] Different people will react differently to treatment, so its important to understand all your treatment options before you begin. […] The most common treatments for pseudobulbar affect include medication and psychotherapy. […] It is critical to get an accurate diagnosis for pseudobulbar affect as treatment can differ between these different conditions. […] One strategy for managing pseudobulbar affect is through medication. Medication can minimize the severity of emotional outbursts and help these outbursts to occur less frequently. […] One of the primary treatments for pseudobulbar affect includes antidepressant medications.

• #8 Pseudobulbar affect – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudobulbar-affect/diagnosis-treatment/drc-20353741

  PBA is often misdiagnosed as depression, bipolar disorder, generalized anxiety disorder, schizophrenia, a personality disorder and epilepsy. […] The goal of treatment for pseudobulbar affect (PBA) is to reduce the severity and frequency of emotional outbursts. Medication options include: […] Antidepressants, such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), can help reduce the frequency and severity of your PBA episodes. […] Dextromethorphan hydrobromide and quinidine sulfate (Nuedexta). This is the only medication approved by the Food and Drug Administration that is designed to specifically treat PBA. […] Your doctor will help you choose the best therapy for you, taking into account possible medication side effects and any other conditions you have and medications you use. […] An occupational therapist also can help you develop ways to complete everyday tasks despite your PBA.

• #9 Nuedexta for the Treatment Of Pseudobulbar Affect

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3737988/

  Dextromethorphan/quinidine (nuedexta) for pseudobulbar affect […] Dextromethorphan/quinidine (Nuedexta) is the only FDA-approved therapy for PBA in patients with ALS and MS. Clinical trials have shown a decreased incidence of PBA episodes with therapy. […] Dextromethorphan/quinidine is indicated for the treatment of pseudobulbar affect (PBA) and has shown efficacy in patients with underlying ALS and MS. Dextromethorphan’s mechanism of action in treating PBA is not known. […] SSRIs and tricyclic antidepressants are also used in an off-label fashion for PBA, but success in treating PBA exacerbations with these agents has been limited.

• #10 Pseudobulbar affect: prevalence and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3849173/

  In October 2010, the US Food and Drug Administration (FDA) approved Nuedexta (Avanir Pharmaceuticals, Aliso Viejo, CA, USA) for the treatment of PBA, making this the first FDA-approved drug for this indication. […] The American Academy of Neurology published guidelines in 2009 which recommended that dextromethorphan/quinidine should be considered for treatment of PBA in patients with ALS, if approved by the FDA and if side effects are acceptable. […] By managing PBA with an appropriate pharmacologic approach, clinicians can have a meaningful impact on symptoms that are socially embarrassing and functionally limiting for these patients.

• #11 Pseudobulbar affect (pathological laughing and crying) | MS Trust

  https://mstrust.org.uk/a-z/pseudobulbar-affect-pathological-laughing-and-crying

  Pseudobulbar affect can be mistaken for depression, because it often involves crying. […] The aim of treatment for PBA is to reduce the frequency and severity of episodes. The mainstay of treatment has been the 'off-label’ use of antidepressants which target the neurotransmitters noradrenaline, serotonin and glutamate. […] Both tricyclic antidepressants such as amitriptyline, imipramine and nortriptyline, and selective serotonin reuptake inhibitors (SSRIs) including fluoxetine, citalopram and sertraline are used. […] The NICE MS Guideline suggests that amitriptyline be tried as a treatment for emotional lability in people with MS. […] In 2013, the European Medicine Agency (EMA) licensed a new combination drug called Nuedexta for treating pseudobulbar affect in MS and other neurological conditions, including MND. […] It is thought that Nuedexta takes longer to have an effect on pseudobulbar affect than antidepressants, taking up to four to five weeks to work.

• #12 Pharmacotherapeutic Management of Pseudobulbar Affect

  https://www.ajmc.com/view/pharmacotherapeutic-management-of-pseudobulbar-affect

  Other drugs have been used for PBA, primarily in case studies and limited clinical studies. […] Off-label prescribing of prescription drugs is a legitimate medical practice that is typically reserved for cases in which there is no FDA-approved therapy for a particular condition or when approved therapies are ineffective, not tolerated, or contraindicated for a particular patient. […] Currently, the only FDA-approved drug for the treatment of PBA is a capsule formulation that combines dextromethorphan hydrobromide (20 mg) and quinidine sulfate (10 mg). […] Dextromethorphan, which is most commonly used as an antitussive in cough and cold remedies, has CNS activity both as an uncompetitive antagonist of the NMDA-sensitive ionotropic glutamate receptor and as a sigma-1 receptor agonist. […] Double-blind clinical studies provide supporting data on the efficacy of dextromethorphan/quinidine in the treatment of PBA.

• #13 Pseudobulbar Affect in Parkinsonian Disorders: A Review

  https://www.e-jmd.org/journal/view.php?doi=10.14802/jmd.18051

  Dextromethorphan/quinidine DMQ, currently the only FDA-approved treatment for PBA, was specifically designed for treatment of PBA. […] While the main therapeutic component of DMQ is dextromethorphan, quinidine acts to inhibit the CYP450 enzyme CYP2D6, which rapidly metabolizes dextromethorphan, thereby increasing the plasma concentration of dextromethorphan and allowing for lower dosages of the drug to be used. […] At the present time, there are no studies exploring the efficacy of DMQ in treating PBA in parkinsonian disorders. […] PBA is a distressing neurological condition that is relatively common but underappreciated in the parkinsonian population. […] Greater attention to and exploration of PBA in patients with parkinsonian disorders is urgently needed.

• #14 Mayo Clinic Health Library – Pseudobulbar affect | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20192124

  Pseudobulbar affect often goes undiagnosed or is mistaken for mood disorders. Once diagnosed, however, pseudobulbar affect can be managed with medication. […] The goal of treatment for pseudobulbar affect (PBA) is to reduce the severity and frequency of emotional outbursts. Medication options include: […] Antidepressants, such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), can help reduce the frequency and severity of your PBA episodes. Antidepressants for the treatment of PBA are typically prescribed at doses lower than are those used to treat depression. […] Dextromethorphan hydrobromide and quinidine sulfate (Nuedexta). This is the only medication approved by the Food and Drug Administration that is designed to specifically treat PBA. A study on people with MS and ALS showed that those taking the medication had only about half as many laughing and crying episodes as did those taking the placebo. […] Your doctor will help you choose the best therapy for you, taking into account possible medication side effects and any other conditions you have and medications you use. […] An occupational therapist also can help you develop ways to complete everyday tasks despite your PBA.

• #15 Pseudobulbar Affect Versus Depression: Issues in Diagnosis and Treatment

  https://www.psychiatrictimes.com/view/pseudobulbar-affect-versus-depression-issues-diagnosis-and-treatment

  A 12-week, double-blind, randomized, controlled trial of dextromethorphan/quinidine reported a reduction in the PBA episode rate of 46.9 % to 49.0 %, depending on dextromethorphan dose, compared with placebo. […] The recognition and diagnosis of PBA is necessary to ensure appropriate treatment and improved quality of life.

• #16 Review of the Diagnosis and Management of Pseudobulbar Affect

  https://www.uspharmacist.com/article/review-of-the-diagnosis-and-management-of-pseudobulbar-affect

  The only FDA-approved product for PBA, Nuedexta, is a fixed-dose combination of dextromethorphan hydrobromide/quinidine sulfate (DHQ). […] The first trial demonstrating efficacy for this combination therapy was a multicenter, randomized, parallel-group, double-blind, controlled, three-arm study to test a defined combination of dextromethorphan hydrobromide (DH) and quinidine sulfate (Q) (AVP-923) for the treatment of pseudobulbar affect in ALS. […] When determining the appropriate PBA treatment, the treating clinician must consider drug-drug interactions, adverse effects, impact on neurological condition/co-morbidities, and benefit to the PBA symptoms. […] The FDA-approved dosing of Nuedexta for PBA consists of a titration of one capsule of dextromethorphan 20 mg/quinidine 10 mg taken by mouth once daily for 7 days, then increased to the maintenance dose of one capsule of dextromethorphan 20 mg/quinidine 10 mg every 12 hours, not to exceed dextromethorphan 40 mg/quinidine 20 mg in a 24-hour period.

• #17 Calming Emotional Outbursts from Pseudobulbar Affect

  https://www.brainandlife.org/articles/research-points-to-an-effective-treatment-for-different-neurological-conditions

  The U.S. Food and Drug Administration (FDA) ultimately approved the lower dose (20 mg DM/10 mg quinidine) in 2010. […] Since then, a year-long study of Nuedexta in 533 neurological patients with PBA found significant improvements in PBA symptoms regardless of the underlying condition, with no signs of heart rhythm disorders or other serious side effects. […] Researchers are recruiting patients for more clinical trials evaluating the drug in patients with Alzheimer’s disease, stroke, dementia, and TBI—all conditions that may involve inappropriate emotional responses. […] Dr. Shefner, who also cares for ALS patients, has been prescribing the drug for more than a decade. […] In his experience, Dr. Tarulli says the drug doesn’t cure all the symptoms of PBA, but it does reduce the number of daily episodes.

• #18 Treatment for Pseudobulbar Affect

  https://resources.healthgrades.com/right-care/brain-and-nerves/understanding-treatment-options-for-pseudobulbar-affect

  Currently, Nuedexta is the only medication with approval from the Food and Drug Administration (FDA) to treat PBA. Nuedexta is a combination of two drugs, dextromethorphan and quinidine. As the only FDA-approved drug, doctors usually consider it to be a first-line treatment for PBA. […] Studies of the drug found that it reduced symptoms and helped people have more days without episodes of PBA. People taking the drug also reported improvements in quality of life and relationships. […] […] If you cannot take Nuedexta, there are second-line treatments available. These medications are off-label for PBA, meaning doctors prescribe it for a condition other than its FDA-approved uses. […] Common treatments include antidepressants such as: citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox), nortriptyline (Pamelor), sertraline (Zoloft). Although PBA and depression are different conditions, antidepressants can be effective for managing PBA. […] Talk with your doctor about treatment options for PBA. As a team, you, your doctor, and your caregivers can manage PBA and find relief.

• #19 What is PBA: Take a closer look at PBA symptoms

  https://www.nuedextahcp.com/what-is-pba

  NUEDEXTA is indicated for the treatment of pseudobulbar affect (PBA). PBA occurs secondary to a variety of otherwise unrelated neurologic conditions, and is characterized by involuntary, sudden, and frequent episodes of laughing and/or crying. PBA episodes typically occur out of proportion or incongruent to the underlying emotional state. PBA is a specific condition, distinct from other types of emotional lability that may occur in patients with neurologic disease or injury. […] Learn 3 steps to help you assess patients for PBA. […] Eligible healthcare providers can request a free 10-day sample of NUEDEXTA for appropriate patients. […] Dr Nick Fisher shares why some doctors screen all their patients for PBA. […] The most common adverse reactions (incidence of 3% and two-fold greater than placebo) in patients taking NUEDEXTA are diarrhea, dizziness, cough, vomiting, asthenia, peripheral edema, urinary tract infection, influenza, increased gamma-glutamyltransferase, and flatulence.

• #20 Dynamic Link Display

  https://journals.lww.com/neurotodayonline/fulltext/2005/07000/new_therapy_targets_pseudobulbar_affect_in_ms.1.aspx

  MIAMI BEACH A drug combining dextromethorphan and quinidine (AVP-923) was effective in treating pseudobulbar affect in patients with multiple sclerosis (MS), investigators reported in April here at the AAN Annual Meeting. […] Dr. Hillel noted that antidepressants such as amitriptyline had been used for years to treat pseudobulbar effect, but they had unpleasant side effects. […] Significantly more patients treated with AVP-923 experienced a decrease in their CNS-LS scores than those treated with placebo, Dr. Panitch said. In addition, AVP-923-treated patients achieved a 46 percent reduction in the number of episodes. […] QoL and QoR were also greatly improved with AVP-923. […] My sense is that this agent has a quicker onset of action than selective serotonin uptake inhibitors (SSRIs), which have also been used to treat pseudobulbar affect. […] Dr. Hillel Panitch said that antidepressants have been used for years to treat pseudobulbar affect, but they can have unpleasant side effects.

• #21 Pseudobulbar affect (pathological laughing and crying) | MS Trust

  https://mstrust.org.uk/a-z/pseudobulbar-affect-pathological-laughing-and-crying

  Pseudobulbar affect can be mistaken for depression, because it often involves crying. […] The aim of treatment for PBA is to reduce the frequency and severity of episodes. The mainstay of treatment has been the 'off-label’ use of antidepressants which target the neurotransmitters noradrenaline, serotonin and glutamate. […] Both tricyclic antidepressants such as amitriptyline, imipramine and nortriptyline, and selective serotonin reuptake inhibitors (SSRIs) including fluoxetine, citalopram and sertraline are used. […] The NICE MS Guideline suggests that amitriptyline be tried as a treatment for emotional lability in people with MS. […] In 2013, the European Medicine Agency (EMA) licensed a new combination drug called Nuedexta for treating pseudobulbar affect in MS and other neurological conditions, including MND. […] It is thought that Nuedexta takes longer to have an effect on pseudobulbar affect than antidepressants, taking up to four to five weeks to work.

• #22 Pseudobulbar affect: prevalence and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3849173/

  The goal of treatment of PBA is to diminish the severity and frequency of episodes. […] The serotonergic action of SSRIs and TCAs appears to be the most significant therapeutic mechanism in treatment of PBA, via an increase in availability of serotonin at the synapses in corticolimbic and cerebellar pathways. […] In contrast to SSRIs and TCAs, dextromethorphan inhibits glutamatergic neurotransmission via actions at a variety of locations including N-methyl-D-aspartate receptors and -1 receptors. […] Until recently, all treatments have, of necessity, been off-label. […] The efficacy of antidepressants appears to be unrelated to the treatment of depression, based upon several pieces of evidence: 1) the onset of action may occur within a few days, which is faster than expected for depression; 2) doses are lower than those usually used to treat depression; and 3) most patients with PBA are not depressed.

• #23 Pharmacotherapeutic Management of Pseudobulbar Affect

  https://www.ajmc.com/view/pharmacotherapeutic-management-of-pseudobulbar-affect

  The primary neurotransmitters involved in PBA are serotonin and glutamate, and pharmacologic treatments have focused on drugs that modulate these neurotransmitters. […] Until 2010, there had been no FDA-approved drug with an indication for PBA. […] Drugs in these classes are used to treat various central nervous system (CNS) conditions and target serotonin, glutamate, or dopamine receptors. […] Classic tricyclic antidepressants (TCAs) are commonly used to treat PBA. […] The time to observable alleviation of PBA symptoms may also be shorter compared with alleviation of depressive symptoms by TCAs. […] Although the lower doses could mitigate risks, the well-known adverse effects (AEs) of TCAs may limit their use in the treatment of PBA. […] Selective serotonin reuptake inhibitors (SSRIs) are also used off label for the treatment of PBA.

• #24 Pseudobulbar affect (pathological laughing and crying) | MS Trust

  https://mstrust.org.uk/a-z/pseudobulbar-affect-pathological-laughing-and-crying

  Pseudobulbar affect can be mistaken for depression, because it often involves crying. […] The aim of treatment for PBA is to reduce the frequency and severity of episodes. The mainstay of treatment has been the 'off-label’ use of antidepressants which target the neurotransmitters noradrenaline, serotonin and glutamate. […] Both tricyclic antidepressants such as amitriptyline, imipramine and nortriptyline, and selective serotonin reuptake inhibitors (SSRIs) including fluoxetine, citalopram and sertraline are used. […] The NICE MS Guideline suggests that amitriptyline be tried as a treatment for emotional lability in people with MS. […] In 2013, the European Medicine Agency (EMA) licensed a new combination drug called Nuedexta for treating pseudobulbar affect in MS and other neurological conditions, including MND. […] It is thought that Nuedexta takes longer to have an effect on pseudobulbar affect than antidepressants, taking up to four to five weeks to work.

• #25 Pharmacotherapeutic Management of Pseudobulbar Affect

  https://www.ajmc.com/view/pharmacotherapeutic-management-of-pseudobulbar-affect

  The primary neurotransmitters involved in PBA are serotonin and glutamate, and pharmacologic treatments have focused on drugs that modulate these neurotransmitters. […] Until 2010, there had been no FDA-approved drug with an indication for PBA. […] Drugs in these classes are used to treat various central nervous system (CNS) conditions and target serotonin, glutamate, or dopamine receptors. […] Classic tricyclic antidepressants (TCAs) are commonly used to treat PBA. […] The time to observable alleviation of PBA symptoms may also be shorter compared with alleviation of depressive symptoms by TCAs. […] Although the lower doses could mitigate risks, the well-known adverse effects (AEs) of TCAs may limit their use in the treatment of PBA. […] Selective serotonin reuptake inhibitors (SSRIs) are also used off label for the treatment of PBA.

• #26 Pharmacotherapeutic Management of Pseudobulbar Affect

  https://www.ajmc.com/view/pharmacotherapeutic-management-of-pseudobulbar-affect

  The primary neurotransmitters involved in PBA are serotonin and glutamate, and pharmacologic treatments have focused on drugs that modulate these neurotransmitters. […] Until 2010, there had been no FDA-approved drug with an indication for PBA. […] Drugs in these classes are used to treat various central nervous system (CNS) conditions and target serotonin, glutamate, or dopamine receptors. […] Classic tricyclic antidepressants (TCAs) are commonly used to treat PBA. […] The time to observable alleviation of PBA symptoms may also be shorter compared with alleviation of depressive symptoms by TCAs. […] Although the lower doses could mitigate risks, the well-known adverse effects (AEs) of TCAs may limit their use in the treatment of PBA. […] Selective serotonin reuptake inhibitors (SSRIs) are also used off label for the treatment of PBA.

• #27 Review of the Diagnosis and Management of Pseudobulbar Affect

  https://www.uspharmacist.com/article/review-of-the-diagnosis-and-management-of-pseudobulbar-affect

  PBA is a type of affect lability characterized by sudden, frequent, and uncontrollable episodes of crying and/or laughing. […] The treatments utilized for PBA target serotonin, norepinephrine, and glutamate with goals of reducing severity and episode frequency of PBA. […] The goals of pharmacotherapy are to reduce both the severity and frequency of PBA episodes. The most commonly used treatments target the primary neurotransmitters implicated in PBA, serotonin and glutamate. […] Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are used in clinical practice, even though the data are limited. […] In small trials and case studies with poststroke, ALS, MS, and brain-injury patients, the SSRIs that have shown a reduction in PBA-episode frequency and severity include escitalopram, fluvoxamine, citalopram, fluoxetine, and paroxetine.

• #28 Pseudobulbar affect | MedLink Neurology

  https://www.medlink.com/articles/pseudobulbar-affect

  In 2010, dextromethorphan-quinidine received approval from the U.S. Food and Drug Administration as first-in-class pharmacotherapy for emotional lability. […] Selective serotonin reuptake inhibitors (SSRIs) are the drugs of choice for pathologic crying after brain injury and accompanying depression. […] Treatment with sertraline has been found to improve patients with pathologic crying and laughter without significant side effects. […] Significant and rapid recovery in both pathologic laughing and crying following stroke has been reported with lamotrigine treatment. […] Duloxetine, a serotonin-norepinephrine reuptake inhibitor approved for the treatment of depression and neuropathic pain, is also useful for the treatment of pathologic laughter and crying.

• #29 Pseudobulbar Affect (PBA) | MSAA

  https://mymsaa.org/ms-information/symptoms/pba/

  Nuedexta (dextromethorphan hydrobromide and quinidine sulfate) is the only FDA-approved treatment specifically for PBA at this time. […] Some doctors advocate using certain antidepressant medications, including the SSRIs (selective serotonin reuptake inhibitors), such as Celexa (citalopram) and Zoloft (sertraline). […] While these medications may well help to manage the symptoms of PBA, they do not cure its underlying cause. […] If you have PBA, your multiple sclerosis neurologist will determine which medication is best for you.

• #30 Pseudobulbar affect: prevalence and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3849173/

  The goal of treatment of PBA is to diminish the severity and frequency of episodes. […] The serotonergic action of SSRIs and TCAs appears to be the most significant therapeutic mechanism in treatment of PBA, via an increase in availability of serotonin at the synapses in corticolimbic and cerebellar pathways. […] In contrast to SSRIs and TCAs, dextromethorphan inhibits glutamatergic neurotransmission via actions at a variety of locations including N-methyl-D-aspartate receptors and -1 receptors. […] Until recently, all treatments have, of necessity, been off-label. […] The efficacy of antidepressants appears to be unrelated to the treatment of depression, based upon several pieces of evidence: 1) the onset of action may occur within a few days, which is faster than expected for depression; 2) doses are lower than those usually used to treat depression; and 3) most patients with PBA are not depressed.

• #31 Mayo Clinic Health Library – Pseudobulbar affect | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20192124

  Pseudobulbar affect often goes undiagnosed or is mistaken for mood disorders. Once diagnosed, however, pseudobulbar affect can be managed with medication. […] The goal of treatment for pseudobulbar affect (PBA) is to reduce the severity and frequency of emotional outbursts. Medication options include: […] Antidepressants, such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), can help reduce the frequency and severity of your PBA episodes. Antidepressants for the treatment of PBA are typically prescribed at doses lower than are those used to treat depression. […] Dextromethorphan hydrobromide and quinidine sulfate (Nuedexta). This is the only medication approved by the Food and Drug Administration that is designed to specifically treat PBA. A study on people with MS and ALS showed that those taking the medication had only about half as many laughing and crying episodes as did those taking the placebo. […] Your doctor will help you choose the best therapy for you, taking into account possible medication side effects and any other conditions you have and medications you use. […] An occupational therapist also can help you develop ways to complete everyday tasks despite your PBA.

• #32 Pseudobulbar affect: prevalence and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3849173/

  The goal of treatment of PBA is to diminish the severity and frequency of episodes. […] The serotonergic action of SSRIs and TCAs appears to be the most significant therapeutic mechanism in treatment of PBA, via an increase in availability of serotonin at the synapses in corticolimbic and cerebellar pathways. […] In contrast to SSRIs and TCAs, dextromethorphan inhibits glutamatergic neurotransmission via actions at a variety of locations including N-methyl-D-aspartate receptors and -1 receptors. […] Until recently, all treatments have, of necessity, been off-label. […] The efficacy of antidepressants appears to be unrelated to the treatment of depression, based upon several pieces of evidence: 1) the onset of action may occur within a few days, which is faster than expected for depression; 2) doses are lower than those usually used to treat depression; and 3) most patients with PBA are not depressed.

• #33 New Pseudobulbar Affect (PBA) treatments 2025 | Everyone.org

  https://everyone.org/explore/treatment/?id=58

  The choice of treatment for Pseudobulbar Affect depends on several factors, including the severity and frequency of symptoms, patient comorbidities, potential drug interactions, and patient preferences. […] Current medical approaches focus primarily on symptom management, aiming to reduce the frequency, severity, and social impact of involuntary emotional outbursts characteristic of this condition. […] While these treatments can significantly improve quality of life for patients with PBA by reducing the frequency and intensity of emotional outbursts, they do not offer a permanent cure. […] In summary, there is currently no cure for Pseudobulbar Affect. Existing treatments, including FDA-approved and off-label medications, focus exclusively on symptom management rather than addressing or reversing the underlying neurological dysfunction.

• #34 Review of the Diagnosis and Management of Pseudobulbar Affect

  https://www.uspharmacist.com/article/review-of-the-diagnosis-and-management-of-pseudobulbar-affect

  The only FDA-approved product for PBA, Nuedexta, is a fixed-dose combination of dextromethorphan hydrobromide/quinidine sulfate (DHQ). […] The first trial demonstrating efficacy for this combination therapy was a multicenter, randomized, parallel-group, double-blind, controlled, three-arm study to test a defined combination of dextromethorphan hydrobromide (DH) and quinidine sulfate (Q) (AVP-923) for the treatment of pseudobulbar affect in ALS. […] When determining the appropriate PBA treatment, the treating clinician must consider drug-drug interactions, adverse effects, impact on neurological condition/co-morbidities, and benefit to the PBA symptoms. […] The FDA-approved dosing of Nuedexta for PBA consists of a titration of one capsule of dextromethorphan 20 mg/quinidine 10 mg taken by mouth once daily for 7 days, then increased to the maintenance dose of one capsule of dextromethorphan 20 mg/quinidine 10 mg every 12 hours, not to exceed dextromethorphan 40 mg/quinidine 20 mg in a 24-hour period.

• #35 New Pseudobulbar Affect (PBA) treatments 2025 | Everyone.org

  https://everyone.org/explore/treatment/?id=58

  Several medications, although not FDA-approved specifically for PBA, are commonly used off-label to manage symptoms due to their effects on neurotransmitter systems involved in emotional regulation. […] SSRIs, such as sertraline and fluoxetine, are frequently prescribed off-label for PBA. […] TCAs, including amitriptyline and nortriptyline, have also been used off-label to manage PBA symptoms. […] Researchers continue to explore additional therapeutic options for PBA, including medications traditionally used for other neurological conditions. […] In addition to medication, non-pharmacological interventions such as Cognitive Behavioral Therapy (CBT) can play a supportive role in managing PBA. […] Selecting the most appropriate treatment for PBA involves careful consideration of several factors, including the underlying neurological condition, severity and frequency of emotional episodes, medication side effects, patient preference, and cost considerations.

• #36 New Pseudobulbar Affect (PBA) treatments 2025 | Everyone.org

  https://everyone.org/explore/treatment/?id=58

  Nuedexta remains the only FDA-approved medication specifically indicated for PBA and is often considered first-line therapy. […] The management of Pseudobulbar Affect (PBA) primarily involves pharmacological treatments aimed at reducing the frequency and severity of involuntary emotional outbursts. […] In addition to Nuedexta, various medications have been used off-label to manage symptoms of Pseudobulbar Affect. […] SSRIs such as sertraline, fluoxetine, citalopram, and paroxetine are commonly used off-label to treat PBA symptoms. […] TCAs such as amitriptyline and nortriptyline have also been used off-label to manage PBA symptoms. […] Ongoing research continues to explore alternative pharmacological and non-pharmacological approaches for managing PBA symptoms. […] Although pharmacological treatments remain the cornerstone of PBA management, non-pharmacological interventions may also provide supportive benefits.

• #37 Treatment for Pseudobulbar Affect

  https://resources.healthgrades.com/right-care/brain-and-nerves/understanding-treatment-options-for-pseudobulbar-affect

  Currently, Nuedexta is the only medication with approval from the Food and Drug Administration (FDA) to treat PBA. Nuedexta is a combination of two drugs, dextromethorphan and quinidine. As the only FDA-approved drug, doctors usually consider it to be a first-line treatment for PBA. […] Studies of the drug found that it reduced symptoms and helped people have more days without episodes of PBA. People taking the drug also reported improvements in quality of life and relationships. […] […] If you cannot take Nuedexta, there are second-line treatments available. These medications are off-label for PBA, meaning doctors prescribe it for a condition other than its FDA-approved uses. […] Common treatments include antidepressants such as: citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox), nortriptyline (Pamelor), sertraline (Zoloft). Although PBA and depression are different conditions, antidepressants can be effective for managing PBA. […] Talk with your doctor about treatment options for PBA. As a team, you, your doctor, and your caregivers can manage PBA and find relief.

• #38 Pseudobulbar affect – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudobulbar-affect/diagnosis-treatment/drc-20353741

  PBA is often misdiagnosed as depression, bipolar disorder, generalized anxiety disorder, schizophrenia, a personality disorder and epilepsy. […] The goal of treatment for pseudobulbar affect (PBA) is to reduce the severity and frequency of emotional outbursts. Medication options include: […] Antidepressants, such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), can help reduce the frequency and severity of your PBA episodes. […] Dextromethorphan hydrobromide and quinidine sulfate (Nuedexta). This is the only medication approved by the Food and Drug Administration that is designed to specifically treat PBA. […] Your doctor will help you choose the best therapy for you, taking into account possible medication side effects and any other conditions you have and medications you use. […] An occupational therapist also can help you develop ways to complete everyday tasks despite your PBA.

• #39 Pseudobulbar Affect Treatment: Managing Emotional Outbursts

  https://www.flintrehab.com/pseudobulbar-affect-treatment/?srsltid=AfmBOoo_FoAz7IR7KcQxaaC-Kly2JbfWzEjMZHjEwROz8SWbKy4NJX36

  Fortunately, the FDA has approved a medication designed specifically to treat PBA, called Nuedexta. […] Talk with your doctor about your symptoms to help create a treatment plan that is optimal for your unique needs. […] While medication is the only scientifically verified way to treat PBA, many stroke survivors have found success using different coping mechanisms. […] In addition to medication treatment for pseudobulbar affect, some survivors use coping techniques to address emotional outbursts. […] Medications such as Nuedexta can help address your PBA symptoms and allow you to regain control over your emotions. […] Talk with your doctor about what medication options may be best for you. […] Strategies such as emotional practice, relaxation techniques, and distraction may be able to reduce the frequency of your outbursts.

• #40 Pseudobulbar affect – Wikipedia

  https://en.wikipedia.org/wiki/Pseudobulbar_affect

  PBA is a consequence of another neurologic disorder or brain injury. […] Education of patients, families, and caregivers is an important component of the appropriate treatment of PBA. […] Traditionally, antidepressants such as sertraline, fluoxetine, citalopram, nortriptyline and amitriptyline have been prescribed with some efficacy. […] Dextromethorphan/quinidine is a combination of these two generic drugs, and is the first FDA-approved drug for the treatment of PBA, approved on October 29, 2010. […] Overall, the trial showed a statistically significant benefit from taking a combination of dextromethorphan and quinidine, with both dosages being safe and well tolerated.

• #41 Pseudobulbar Affect Versus Depression: Issues in Diagnosis and Treatment

  https://www.psychiatrictimes.com/view/pseudobulbar-affect-versus-depression-issues-diagnosis-and-treatment

  Pseudobulbar affect (PBA) is a neurologic condition that is characterized by brief episodes of uncontrollable, sudden, and inappropriate emotions. […] Pseudobulbar affect was diagnosed and Mr. A was started on a new treatment regimen. The symptoms decreased in frequency and intensity. […] There is no cure for PBA, but treatment can reduce the intensity and frequency of symptoms with the goal of improving well-being. The first step is to provide education to both the patient and his or her family. This will decrease the embarrassment associated with uncontrollable episodes and improve social functioning. […] Until recently, the main treatment for PBA was antidepressants. […] The first treatment for PBA was FDA approved in 2010. Nuedexta is a fixed combination dosage capsule with 20 mg of dextromethorphan hydrobromide and 10 mg of quinidine sulfate.

• #42

  https://pspawareness.com/blogs/psp-q-a/pseudobulbar-affect-in-progressive-supranuclear-palsy-shedding-light-on-a-misunderstood-symptom?srsltid=AfmBOop1Di368FfOkBS-NIceob7BoCkQBaA16ks6i6TrF34HknBMIeLl

  Counseling and psychotherapy can be beneficial for individuals with PSP and PBA, as well as their families. Mental health professionals can provide coping strategies, emotional support, and guidance on managing PBA episodes. Additionally, support groups specifically for PSP or PBA can offer a safe space for individuals and their families to share their experiences, learn from others, and reduce feelings of isolation. […] Understanding PBA and its relationship with PSP is crucial for managing symptoms and advocating for appropriate care. Educating oneself about the condition, available treatments, and strategies for symptom management can empower individuals and their families to make informed decisions about their care. Raising awareness about PBA in the broader community can also help reduce stigma and foster understanding and support. […] Through a combination of medication, therapy, and supportive care, individuals with PSP and PBA can help manage their symptoms, improve their quality of life, and foster a sense of understanding and support within their communities.

• #43 Pseudobulbar Affect Treatment: Managing Emotional Outbursts

  https://www.flintrehab.com/pseudobulbar-affect-treatment/?srsltid=AfmBOoo_FoAz7IR7KcQxaaC-Kly2JbfWzEjMZHjEwROz8SWbKy4NJX36

  Fortunately, the FDA has approved a medication designed specifically to treat PBA, called Nuedexta. […] Talk with your doctor about your symptoms to help create a treatment plan that is optimal for your unique needs. […] While medication is the only scientifically verified way to treat PBA, many stroke survivors have found success using different coping mechanisms. […] In addition to medication treatment for pseudobulbar affect, some survivors use coping techniques to address emotional outbursts. […] Medications such as Nuedexta can help address your PBA symptoms and allow you to regain control over your emotions. […] Talk with your doctor about what medication options may be best for you. […] Strategies such as emotional practice, relaxation techniques, and distraction may be able to reduce the frequency of your outbursts.

• #44 Pseudobulbar Affect (PBA) After a Stroke – Amplify Speech Therapy

  https://www.amplifyspeechtherapy.com/post/pseudobulbar-affect-after-stroke

  PBA is when your emotions act a little wild and don’t match what’s happening. For example, you might burst into laughter during a serious conversation, or tears might flow even when you’re not sad. […] The good news is there are ways to manage PBA. You don’t have to ride that emotional rollercoaster forever. Here’s what you can do: […] Talk to a Doctor. Your healthcare team can help. There is a medicine prescribed for PBA, but it doesn’t help everyone. It’s a discussion to have with your doctor. But you might also request a referral to speech therapy to get help in developing strategies to address PBA. […] Share your condition with family and friends. It is important that your family and friends understand that this is part of a medical condition. Relationships can be harmed by inappropriate laughter or excessive tears. But when people understand PBA, they can be more supportive and less judgmental during emotional episodes.

• #45 Pseudobulbar Affect

  https://www.bcm.edu/healthcare/specialties/neurology/neuropsychology/pseudobulbar-affect

  Nuedexta is currently the only pharmacological treatment approved by the FDA for PBA. […] Antidepressants, such as amitriptyline, fluoxetine, and citalopram, can also be used to treat PBA. […] Eliciting the opposite emotion can help control their emotions. For example, during an episode of uncontrollable crying having someone tell a joke can stop the crying spell.

• #46 Pseudobulbar affect (PBA) | EBSCO Research Starters

  https://www.ebsco.com/research-starters/health-and-medicine/pseudobulbar-affect-pba

  PBA can be diagnosed with a number of testing methods. The Pathological Laughing and Crying Scale (PLACS) involves a set of questions about the severity of laughing or crying fits and how they are connected to a persons mood and social setting. The Center for Neurologic Study-Lability Scale (CNS-LS) is another diagnosis method that involves a set of questions about symptoms. Treatment of PBA often involves prescription medications such as anti-depressants, which are thought to control the symptoms of the disorder. […] In 2010, the Food and Drug Administration (FDA) approved a new drug to specifically treat PBA called dextromethorphan/quinidine (Nuedexta), which studies have shown can also help control PBA outbursts in patients with MS and ALS. […] Doctors also recommend several methods to cope with PBA. For instance, when patients feel an episode coming on, it is recommended that they shift their position or attempt to distract themselves from the episode. Doctors also encourage patients to learn breathing techniques to regain control of a situation, breathing slowly and deeply during the episode until a sense of control is re-established. After an episode, it is important to relax the body, which likely tenses greatly during the fit. Relax the neck, shoulders, and face while recovering.

• #47 Pseudobulbar affect – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudobulbar-affect/diagnosis-treatment/drc-20353741

  PBA is often misdiagnosed as depression, bipolar disorder, generalized anxiety disorder, schizophrenia, a personality disorder and epilepsy. […] The goal of treatment for pseudobulbar affect (PBA) is to reduce the severity and frequency of emotional outbursts. Medication options include: […] Antidepressants, such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), can help reduce the frequency and severity of your PBA episodes. […] Dextromethorphan hydrobromide and quinidine sulfate (Nuedexta). This is the only medication approved by the Food and Drug Administration that is designed to specifically treat PBA. […] Your doctor will help you choose the best therapy for you, taking into account possible medication side effects and any other conditions you have and medications you use. […] An occupational therapist also can help you develop ways to complete everyday tasks despite your PBA.

• #48 Pseudobulbar Affect (PBA) in Occupational Therapy – Emotional Incontinence? – OT Dude

  https://www.otdude.com/ot-practice/pseudobulbar-affect-pba-in-occupational-therapy-emotional-incontinence/

  Pseudobulbar affect. It goes by many names – emotional lability, emotional incontinence, involuntary emotional control disorder, and more. Is your patient really depressed or bipolar, or is there another root cause for this? […] What can be done to treat this condition? There are ongoing trials with medications to treat psuedobulbar affect. […] Antidepressants […] Dextromethorphan hydrobromide and quinidine sulfate (Nuedexta) […] Occupational therapy can also play an important role in helping patients manage psuedobulbar affect with their occupations. […] It is important to educate both the patient and family members about the condition so that they are aware of it. […] Overall, occupational therapists can help patients who have pseudobulbar affect function in their daily tasks and other occupations using a holistic approach that is tailored to the patient and their caregivers in their environment.

• #49 Pseudobulbar Palsy: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/pseudobulbar-palsy

  Theres no specific treatment for pseudobulbar palsy, but therapies can help manage its features. […] Theres no direct treatment for pseudobulbar palsy. Instead, your healthcare team will recommend therapies for managing its features. […] Various therapies can help with difficulty swallowing (dysphagia) depending on its severity. Some options include: Adjusting eating postures, eating tools and the consistency of your food. […] You may benefit from speech therapy to improve communication. […] Medications can help manage pseudobulbar affect (PBA). Your provider may prescribe: Dextromethorphan/quinidine sulfate (Nuedexta): The U.S. Food and Drug Administration (FDA) has approved a combination of dextromethorphan (a cough suppressant) and a very low dose of quinidine sulfate (a drug used in the past to treat cardiac arrhythmias) as the first drug specifically developed to treat PBA. […] Antidepressants: Tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) may help manage the symptoms of PBA.

• #50 What is the Pseudobulbar Affect? | Neuropsychology Program | Barrow Neurological InstituteSecond Opinion IconSecond Opinion IconGroup 12

  https://www.barrowneuro.org/condition/pseudobulbar-affect/

  Pseudobulbar affect (PBA) describes a disorder that causes a person to experience uncontrollable episodes of crying, laughing, or other emotional displays that are out of context in their social interactions. […] The impact of pseudobulbar affect is substantial. It can result in embarrassment for people suffering from the disorder, their family, and their caregivers. Pseudobulbar affect may also restrict social interactions causing a lower quality of life. […] Medications may help if you suffer from pseudobulbar affect. They may include: […] Antidepressants – tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) may help reduce the frequency and severity of PBA episodes […] Dextromethorphan hydrobromide and quinidine sulfate (Nuedexta) – a medication that is designed to specifically treat PBA and is approved by the Food and Drug Administration (FDA). […] You may find it helpful to see a neurologist, neuropsychologist, or physical medicine and rehab specialist.

• #51 Pseudobulbar affect: prevalence and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3849173/

  In October 2010, the US Food and Drug Administration (FDA) approved Nuedexta (Avanir Pharmaceuticals, Aliso Viejo, CA, USA) for the treatment of PBA, making this the first FDA-approved drug for this indication. […] The American Academy of Neurology published guidelines in 2009 which recommended that dextromethorphan/quinidine should be considered for treatment of PBA in patients with ALS, if approved by the FDA and if side effects are acceptable. […] By managing PBA with an appropriate pharmacologic approach, clinicians can have a meaningful impact on symptoms that are socially embarrassing and functionally limiting for these patients.

• #52 Pharmacotherapeutic Management of Pseudobulbar Affect

  https://www.ajmc.com/view/pharmacotherapeutic-management-of-pseudobulbar-affect

  The AAN recommended that if approved by the FDA, and the AEs were acceptable, dextromethorphan/quinidine should be considered for symptoms of pseudobulbar affect in patients with ALS as a Level B recommendation. […] Dextromethorphan/quinidine is likely to be administered to patients for extended periods of time in chronic and progressive neurological diseases, such as AD, MS, and PD, and it is essential that a long-term safety profile is favorable. […] Education is essential to the clinical management of this condition. […] Treatment options include the off-label use of centrally acting drugs, such as antidepressants, and the FDA-approved drug combination of dextromethorphan and quinidine.

• #53 Enhancing Approaches to the Identification and Management of Pseudobulbar Affect

  https://www.psychiatrist.com/jcp/enhancing-approaches-identification-management-pseudobulbar/

  Treatment options have recently expanded to include dextromethorphan plus quinidine, a sigma-1 agonist and a noncompetitive antagonist of the N-methyl-D-aspartate glutamate receptor. This agent is approved by the US Food and Drug Administration in a fixed-dose combination specifically for PBA. […] The AAN guideline for managing psychiatric disorders in people with MS states that insufficient evidence is available to support or refute the use of antidepressants for PBA. The guideline states that the combination of dextromethorphan and quinidine may be considered. […] Treatment selection should be tailored for the individual, keeping in mind issues relating to safety and tolerability as well as the patients ability to adhere to treatment.

• #54

  https://www.geron.org/News-Events/GSA-News/Press-Room/Press-Releases/pseudobulbar-affect-an-often-overlooked-condition

  PBA typically occurs in patients who have a brain injury or neurologic disorder, such as amyotrophic lateral sclerosis (ALS), extrapyramidal and cerebellar disorders (e.g., Parkinsons disease), multiple sclerosis (MS), traumatic brain injury, Alzheimers disease and other dementias, stroke, and brain tumors. […] However, health care providers are increasingly recognizing PBA as a behavioral symptom that is connected to brain health, and they are assessing for PBA as part of brain health management efforts. […] Goals of treatment for PBA include reducing severity and frequency of episodes. Behavioral strategies should always be considered for patients and caregivers particularly when symptoms are mild or do not impact the patients quality of life and may be adequate for treatment of PBA. Pharmacologic options may also provide benefit for appropriate patients. Implementing nonpharmacologic behavioral strategies along with pharmacologic treatment may produce a synergistic effect.

• #55 Pharmacotherapeutic Management of Pseudobulbar Affect

  https://www.ajmc.com/view/pharmacotherapeutic-management-of-pseudobulbar-affect

  The AAN recommended that if approved by the FDA, and the AEs were acceptable, dextromethorphan/quinidine should be considered for symptoms of pseudobulbar affect in patients with ALS as a Level B recommendation. […] Dextromethorphan/quinidine is likely to be administered to patients for extended periods of time in chronic and progressive neurological diseases, such as AD, MS, and PD, and it is essential that a long-term safety profile is favorable. […] Education is essential to the clinical management of this condition. […] Treatment options include the off-label use of centrally acting drugs, such as antidepressants, and the FDA-approved drug combination of dextromethorphan and quinidine.

• #56 Pseudobulbar Affect – Causes, Symptoms and Treatment | Apollo Hospitals

  https://www.apollohospitals.com/diseases-and-conditions/pseudobulbar-affect-causes-symptoms-and-treatment

  If you have experienced symptoms of PBA, you should consult with a neurologist. They will diagnose your condition, and devise a suitable treatment plan for you. […] Seeking medical consultation from neurologists can help you reduce the symptoms and their frequency. […] Seeking therapy, medical consultation, treatment, and medication will relieve the symptoms.

• #57 Pseudobulbar Affect (PBA) After a Stroke – Amplify Speech Therapy

  https://www.amplifyspeechtherapy.com/post/pseudobulbar-affect-after-stroke

  Talk to others who have PBA. This will provide understanding and support from others who have endured a similar experience. […] For most people who experience PBA, the heightened emotional episodes do lessen with time. There are some strategies you can try to help mitigate the sudden urge to cry or laugh in an inopportune moment. […] Keeping a diary can help you track your emotions and identify triggers for PBA episodes. This self-awareness can be a powerful tool for managing your condition.

• #58 Pseudobulbar Affect in Parkinsonian Disorders: A Review

  https://www.e-jmd.org/journal/view.php?doi=10.14802/jmd.18051

  Dextromethorphan/quinidine DMQ, currently the only FDA-approved treatment for PBA, was specifically designed for treatment of PBA. […] While the main therapeutic component of DMQ is dextromethorphan, quinidine acts to inhibit the CYP450 enzyme CYP2D6, which rapidly metabolizes dextromethorphan, thereby increasing the plasma concentration of dextromethorphan and allowing for lower dosages of the drug to be used. […] At the present time, there are no studies exploring the efficacy of DMQ in treating PBA in parkinsonian disorders. […] PBA is a distressing neurological condition that is relatively common but underappreciated in the parkinsonian population. […] Greater attention to and exploration of PBA in patients with parkinsonian disorders is urgently needed.

• #59 Diagnosis and Treatment of Pseudobulbar Affect

  https://www.todaysgeriatricmedicine.com/archive/MA16p30.shtml

  Pseudobulbar affect (PBA) is a distressing neurologic condition that occurs secondary to brain injury or underlying neurologic disease affecting the brain. […] Improving the diagnosis of PBA may help optimize the management of this underrecognized and underdiagnosed condition and potentially reduce unnecessary medication burden. […] PBA can have a significantly negative impact on psychological well-being, day-to-day functioning, and quality of life by interfering with the completion of activities of daily living, interpersonal relationships, and professional pursuits. […] Identifying and managing PBA can be challenging for clinicians because it is underrecognized and the symptoms overlap with those of depression and other psychiatric disorders. […] Possibly because of its overlap with comorbid psychiatric disorders and depression, antipsychotics, antidepressants, and anxiolytics are sometimes used to manage PBA symptoms.

• #60 Pseudobulbar Affect in Parkinsonian Disorders: A Review

  https://www.e-jmd.org/journal/view.php?doi=10.14802/jmd.18051

  Dextromethorphan/quinidine DMQ, currently the only FDA-approved treatment for PBA, was specifically designed for treatment of PBA. […] While the main therapeutic component of DMQ is dextromethorphan, quinidine acts to inhibit the CYP450 enzyme CYP2D6, which rapidly metabolizes dextromethorphan, thereby increasing the plasma concentration of dextromethorphan and allowing for lower dosages of the drug to be used. […] At the present time, there are no studies exploring the efficacy of DMQ in treating PBA in parkinsonian disorders. […] PBA is a distressing neurological condition that is relatively common but underappreciated in the parkinsonian population. […] Greater attention to and exploration of PBA in patients with parkinsonian disorders is urgently needed.

• #61 New Pseudobulbar Affect (PBA) treatments 2025 | Everyone.org

  https://everyone.org/explore/treatment/?id=58

  The choice of treatment for Pseudobulbar Affect depends on several factors, including the severity and frequency of symptoms, patient comorbidities, potential drug interactions, and patient preferences. […] Current medical approaches focus primarily on symptom management, aiming to reduce the frequency, severity, and social impact of involuntary emotional outbursts characteristic of this condition. […] While these treatments can significantly improve quality of life for patients with PBA by reducing the frequency and intensity of emotional outbursts, they do not offer a permanent cure. […] In summary, there is currently no cure for Pseudobulbar Affect. Existing treatments, including FDA-approved and off-label medications, focus exclusively on symptom management rather than addressing or reversing the underlying neurological dysfunction.

• #62 Nuedexta for the Treatment Of Pseudobulbar Affect

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3737988/

  Dextromethorphan/quinidine (nuedexta) for pseudobulbar affect […] Dextromethorphan/quinidine (Nuedexta) is the only FDA-approved therapy for PBA in patients with ALS and MS. Clinical trials have shown a decreased incidence of PBA episodes with therapy. […] Dextromethorphan/quinidine is indicated for the treatment of pseudobulbar affect (PBA) and has shown efficacy in patients with underlying ALS and MS. Dextromethorphan’s mechanism of action in treating PBA is not known. […] SSRIs and tricyclic antidepressants are also used in an off-label fashion for PBA, but success in treating PBA exacerbations with these agents has been limited.

• #63 Pseudobulbar Affect: Recognize and Treat

  https://www.neurologylive.com/view/pseudobulbar-affect-recognize-and-treat

  Once patients and/or their families become aware of the signs and symptoms of pseudobulbar affect, they are more likely to seek treatment. […] The treatment options for pseudobulbar affect have traditionally included behavioral therapy, tricyclic antidepressants, and SSRIs. While these approaches are well tolerated by patients, efficacy is not optimal. […] Another approach that has been more recently approved is the use of Nuedexta, which is a combination of dextromethorphan and quinidine. Dextromethorphan is an NMDA receptor antagonist and a serotonin and norepinephrine reuptake inhibitor, while quinidine slows the metabolism of dextromethorphan. This combination appears to be well tolerated in a number of studies. The FDA approved Nuedexta, which is dextromethorphan/quinidine for pseudobulbar affect, in 2010 and the studies that have recently emerged have shown good short-term efficacy as well as patient tolerability.

• #64 Enhancing Approaches to the Identification and Management of Pseudobulbar Affect

  https://www.psychiatrist.com/jcp/enhancing-approaches-identification-management-pseudobulbar/

  Treatment options have recently expanded to include dextromethorphan plus quinidine, a sigma-1 agonist and a noncompetitive antagonist of the N-methyl-D-aspartate glutamate receptor. This agent is approved by the US Food and Drug Administration in a fixed-dose combination specifically for PBA. […] The AAN guideline for managing psychiatric disorders in people with MS states that insufficient evidence is available to support or refute the use of antidepressants for PBA. The guideline states that the combination of dextromethorphan and quinidine may be considered. […] Treatment selection should be tailored for the individual, keeping in mind issues relating to safety and tolerability as well as the patients ability to adhere to treatment.

• #65 Calming Emotional Outbursts from Pseudobulbar Affect

  https://www.brainandlife.org/articles/research-points-to-an-effective-treatment-for-different-neurological-conditions

  The U.S. Food and Drug Administration (FDA) ultimately approved the lower dose (20 mg DM/10 mg quinidine) in 2010. […] Since then, a year-long study of Nuedexta in 533 neurological patients with PBA found significant improvements in PBA symptoms regardless of the underlying condition, with no signs of heart rhythm disorders or other serious side effects. […] Researchers are recruiting patients for more clinical trials evaluating the drug in patients with Alzheimer’s disease, stroke, dementia, and TBI—all conditions that may involve inappropriate emotional responses. […] Dr. Shefner, who also cares for ALS patients, has been prescribing the drug for more than a decade. […] In his experience, Dr. Tarulli says the drug doesn’t cure all the symptoms of PBA, but it does reduce the number of daily episodes.

• #66 Pseudobulbar Affect: Signs, Symptoms, and Treatment for Uncontrollable Laughing or Crying – Neurology Advisor

  https://www.neurologyadvisor.com/topics/neurodegenerative-diseases/pseudobulbar-affect-signs-symptoms-and-treatment-for-uncontrollable-laughing-or-crying/

  Pseudobulbar affect is a significant national health issue in the United States, with approximately 2 million individuals affected. […] The goal of treatment of PBA is to diminish the severity and frequency of episodes. The targets of treatment are primarily norepinephrine, serotonin, or glutamate, using tricyclic antidepressants (TCAs), SSRIs, and the cough suppressant dextromethorphan. […] Prior to approval by the US Food and Drug Administration of the combination of dextromethorphan hydrobromide and quinidine sulfate (Nuedexta), all treatments had been off-label. […] Although the mechanisms are not fully understood, serotonergic and glutamatergic transmission appear to play major roles, and there are clear therapeutic benefits in treatment for PBA with SSRIs, TCAs, or dextromethorphan/quinidine. […] With nearly 2 million individuals in the United States experiencing the uncontrollable crying and/or laughing of PBA, this represents a significant national health issue in need of attention from primary care providers. […] Proper diagnosis and appropriate treatment are imperative.

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