Multiple sclerosis (MS) can cause a wide variety of symptoms — some of which you may be expecting and others that can take you by surprise. One you may not expect involves emotional changes that can cause you to laugh or cry for no clear reason, which can result from a neurological condition called pseudobulbar affect (PBA).

“I’m just getting over a relapse, and I find myself bursting into uncontrollable tears for no reason,” wrote a member of MyMSTeam. “I’m not even upset. I’m usually pretty tough, so what’s the deal?”

Many people with pseudobulbar affect have struggled with this question. PBA — also called involuntary emotional expression disorder, emotional lability, or emotional incontinence — commonly occurs in those with MS. It leads to periods in which you can’t seem to stop laughing or crying.

If you sometimes experience uncontrollable laughter or tears, know that it may be an MS symptom. Talk to your doctor to learn more, as there are several treatments that may help you manage this condition.

Symptoms of PBA

Laughing during a funny moment or crying because of a sad movie aren’t signs of PBA on their own. PBA tends to lead to emotional responses that aren’t appropriate for the situation you’re in. For example, you may laugh extremely hard when someone says something that is only a little bit funny or start sobbing when you don’t feel sad.

PBA episodes — which generally last for several minutes or longer — tend to share some common characteristics. During PBA, laughter or crying spells are usually:

• Not under your control
• Unrelated to your actual feelings
• Not triggered by anything in particular
• A change from how you typically express your emotions
• Embarrassing or uncomfortable

Who Does PBA Affect?

Some studies indicate that PBA affects about 1 in 10 people with MS, while other research estimates that the frequency is closer to 50 percent. It may be hard to tell exactly how many people PBA affects because most people don’t know about the condition and it often goes undiagnosed.

It’s not entirely clear why PBA develops, but health experts think that this set of symptoms may appear when you develop lesions (areas of damage) in parts of the brain that help control emotions.

Traumatic brain injuries or other neurological conditions such as stroke, Alzheimer’s disease, Parkinson’s disease, or amyotrophic lateral sclerosis can also cause PBA.

What Is PBA Like for People With MS?

More than 600 people on MyMSTeam have reported that they experience PBA, and many have talked about their experiences.

Some members have reported dealing with laughing spells, sometimes referred to as pathological laughing. “I recently started to laugh and not be able to stop to the point I choke,” said a member.

Another talked about a time they were hospitalized with a major MS flare. “A doctor came in to tell me that I also had deep vein thrombosis, and I couldn’t stop laughing. The more I attempted to hold it in, the worse my laughter became.”

On the other hand, other members live with frequent crying episodes. One member shared, “Today is a crying day. Just thought about winter and snow. Hard to stop the tears. Makes no sense.”

Lamented another, “I slept for another 16 hours straight and woke up in tears. The tears won’t stop, and there is no real reason for them.”

Many members deal with both laughing and crying symptoms. “I noticed that my symptoms weren’t matching the situations going on around me,” one member shared. “[I was] just driving my car with my daughter, and I started crying but then laughing, all over nothing.”

“Uncontrollable laughter started this month,” commented another. “It scares me because I get to a point where I can’t breathe, but I still can’t stop laughing and then the crying starts at the same time. I get very confused.”

PBA May Affect Different Aspects of Your Life

Some members don’t find PBA to be that big of a deal. “Silly things set me off. Mildly embarrassing, but far from the worst,” one wrote.

However, for other people, PBA may lead to anxiety, depression, or a decreased quality of life. Some people may struggle in social situations or have their emotional state affected by symptoms. “I have that condition and it’s embarrassing,” wrote one member.

Another responded, “I understand that feeling. I’ll be sitting on the couch and my kids will be like, what’s wrong with you, Mom?”

Is It Really PBA?

Some people may experience emotional changes during MS that are related to factors besides PBA. Talk to your doctor or neurologist if you’re unsure what is causing these changes. Your health care team can administer questionnaires that help diagnose PBA, including The Center for Neurologic Study-Lability Scale (CNS-LS) or the Pathological Laughter and Crying Scale (PLACS).

Depression

Some people may have a hard time distinguishing PBA from depression, a symptom that affects up to 50 percent of people with MS.

There are a few key differences between PBA and depression, however. Although PBA episodes may feel like they last forever, they generally occur only for a couple of minutes. Depression, on the other hand, leads to ongoing feelings of sadness, hopelessness, irritability, or emptiness that can last for weeks or more. Additionally, PBA doesn’t lead to many of the other symptoms of depression, such as changes in sleep or eating patterns.

Other Mental Health Changes

Episodes of sudden crying could come from other sources of stress that arise while living with a chronic health condition. For example, you may feel sad about the future or frustrated about symptoms like brain fog or memory issues.

“I find myself more emotional and start crying,” shared a MyMSTeam member. “My therapist says it’s normal due to the fact I’m mourning my loss of identity of who I was before I became disabled.”

MS Medications

Some therapies used to treat MS may affect your emotions as a side effect. For example, interferon beta-1a (Avonex, Rebif) can cause mood swings.

One member shared that they experienced uncontrolled crying while using these treatments: “I don’t know if you’re taking an interferon like Avonex or Rebif, but that is why I had to change medications. I couldn’t take the emotional roller coaster anymore.”

How To Treat PBA

The U.S. Food and Drug Administration (FDA) has approved one medication to treat PBA: Nuedexta, a combination of dextromethorphan hydrobromide and quinidine sulfate. Although this medication may take up to four or five weeks to be effective, it can drastically reduce PBA symptoms.

Many MyMSTeam members have reported that this treatment was successful. “I now take Nuedexta and for the most part my emotions stay steady,” wrote one member. “I still have off days or moments but it’s been much better on the medication.”

“Look into Nuedexta! It’s a miracle worker!” advised another.

Several types of antidepressants can also help with PBA when taken at low doses. Your doctor may recommend:

• Tricyclic antidepressants like amitriptyline (Elavil)
• Selective serotonin reuptake inhibitors (SSRIs), such as citalopram (Celexa), sertraline (Zoloft), and fluoxetine (Prozac)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) like duloxetine (Cymbalta)

“That is why my former physician put me on Cymbalta — for mood swings and for my nerve pain,” commented one member. “I had a meltdown in his office one day. I started crying hard for no real reason. Sometimes, I still have crying jags or anger outbursts, but for the most part, the Cymbalta works well.”

Another member agreed. “I started taking Cymbalta for this exact reason, and within two days, I no longer have these feelings,” they said.

Living With PBA

Some members have also shared their journeys toward accepting or getting used to PBA symptoms.

“I started crying out of nowhere. [My caretaker] helped me into bed for a nap, and when I woke up I was much better,” wrote one member.

Another going through a PBA episode posted, “I should go sleep it off.”

During an episode, taking deep breaths, relaxing the muscles in your shoulder and face, and thinking about something else may make the laughing or crying stop. One person advised, “Just try to take a deep breath and realize that it’s going to be OK. It’s just part of your disease and you can get through it.”

Members have also shown their appreciation for talking about PBA and other MS problems on MyMSTeam. “It does help being able to talk to others that know what you’re going through because they have to deal with it as well,” shared one member with PBA

Get Support From Your Team

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 199,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Have you experienced uncontrollable laughing or crying while living with MS? Share your experience in the comments below, or start a conversation by posting on your Activities page.