Do You Cry and Don’t Know Why? It Might Be PBA

Columnist Ed Tobias explores pseudobulbar affect, an underrecognized MS symptom

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by Ed Tobias |

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I often see posts on social media from people with multiple sclerosis asking if crying for no reason is an MS symptom. It can be. Laughing for no reason can be, too. Both can be severe, persistent, unremitting, and unpredictable.

The medical name for this is pseudobulbar affect (PBA), and according to the Multiple Sclerosis Association of America, it affects one in 10 people with MS — and maybe more.

Fellow MS News Today columnist Jenn Powell is one of them. She’s written in her column “Silver Linings“: “I feel anger, sadness, joy, or frustration without provocation. I am sensitive and overreactive. I cry easily and struggle to stop.” Jenn says she has cried over car commercials and while talking on the phone with a customer service representative. She thought she was losing her mind.

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PBA is a brain thing

The cause of PBA isn’t fully understood, but according to the Cleveland Clinic, it’s thought to be due to a disruption of nerve pathways from other areas of the brain to the cerebellum — the part of the brain that helps to ensure our emotional responses are appropriate. That would make sense, since MS causes parts of our central nervous system to short-circuit.

PBA isn’t limited to people with MS. It’s also associated with other illnesses or injuries that can damage the brain, including Alzheimer’s disease, amyotrophic lateral sclerosis, and Parkinson’s disease. Overall, according to PBA Info, a website created by Avanir Pharmaceuticals, 2 million people in the U.S. have been diagnosed with PBA and more than 7 million have PBA-like symptoms.

What can you do about it?

The only treatment for PBA approved by the U.S. Food and Drug Administration is Nuedexta, a combination of the cough suppressant dextromethorphan and a very low dose of quinidine sulfate, a drug that has been used to treat irregular heartbeat. Some antidepressants are also sometimes used to help manage PBA symptoms.

As MS News Today‘s Marisa Wexler reported earlier this month, a publication from The Gerontological Society of America indicated that early detection and management of PBA can help to minimize its impact and improve patients’ quality of life. It recommended that neurologists incorporate questions about mood and emotions into their standard patient assessments.

Jenn suggests something else. She relies on her faith, family, and friends to understand her PBA and says she takes responsibility for her outbursts when they occur.

Medicine can’t do it all, you know.

You’re invited to visit my personal blog at

Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews, and are intended to spark discussion about issues pertaining to multiple sclerosis.


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