Emotionally Hard-wired: Pseudobulbar Affect and MS

Emotionally Hard-wired: Pseudobulbar Affect and MS

I saw a praying mantis this morning. The long, leaf-like oddity caught me off guard. I was transfixed by the beautiful specimen, its prayerful state contrasting starkly with its violent mating ritual. The female is known to eat the head of the male — a shift in temperament at the speed of lightning.

I can relate.

It is natural to experience depression, anger, and anxiety. We grieve what our lives were like before diagnosis. We long to do things we no longer can. These feelings are generally addressed through cognitive therapy or antidepressants.

I experience pseudobulbar affect because of my multiple sclerosis (MS). I have lesions in my amygdala, the area of the brain that is responsible for controlling emotion. I feel anger, sadness, joy, or frustration without provocation. I am sensitive and overreactive. I cry easily and struggle to stop. This emotional disturbance can be extremely embarrassing, to the point where I prefer to be among small groups of people who are familiar with my idiosyncrasies.

Thankfully, my case is mild. My behaviors changed over the course of a year. In addition to extreme irritability, I began to cry. A lot. I went from crying at dog shelter commercials to crying at car commercials. I cried while chatting on the phone with Sears customer service and cried while asking for lettuce at the grocery store. I thought I was losing my mind.

Just under half of those with MS are affected by pseudobulbar affect. The majority are women with secondary progressive multiple sclerosis.

I have relied heavily on my faith, family, and friends. People who know me well love all of me, even my shifts in temperament, which I take responsibility for if the changes are inappropriate. I am quick to apologize. I also try to be mindful. Emotional disturbances may resemble whack-a-mole, but you can bet I knock them down one by one.

I like to believe that I can make a difference. Pseudobulbar affect is not permission to act out. Rather, it is an opportunity to learn. Knowledge is power. Once we know better, we can do better. There will always be emotions I cannot control, but there will also be emotions I can learn to manage.

Life begins at the end of your comfort zone. I am living.


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 Services, and are intended to spark discussion about issues pertaining to multiple sclerosis.

Jennifer Powell is a health writer and weekly columnist on Multiple Sclerosis. She is also an active advocate in the MS community. Jennifer imparts her hopeful optimism into real-life challenges facing the MS community. Prior to writing her column, Jennifer freelanced for several online periodicals including WebMD. When not writing, Jennifer enjoys volunteering with animal rescue, traveling and spending time with her Golden Retriever.
Jennifer Powell is a health writer and weekly columnist on Multiple Sclerosis. She is also an active advocate in the MS community. Jennifer imparts her hopeful optimism into real-life challenges facing the MS community. Prior to writing her column, Jennifer freelanced for several online periodicals including WebMD. When not writing, Jennifer enjoys volunteering with animal rescue, traveling and spending time with her Golden Retriever.
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  1. This article is so useful as I to become emotional at the slightest event in. Y life, I have the primary progress sive MS which I have had for 31years but had no knowledge of the pseudobubolic (not sure I have spelt that right)

    • Barbara Crawford says:

      I also had pseudobulbar disorder. I was prescribed Neudexta and it was completely controlled. It controlled my emotional outbreaks.

      • Jennifer Powell says:

        Hi Christine,

        Thank you so much for writing and sharing your experience with Neudexta. Look forward to looking into this and helping others through your information

        Have a beautiful day


  2. Robby Teer says:

    I’ve been extremely blessed with family and friends who have shown me patience, kindness, consideration, understanding, and empathy within regards to the ups and downs I face on the daily roller coaster ride that is MS. However, the 1 single most important person contained within all of this, my “WIFE”, has given and/or shown me the LEAST of all these. I understand she’s “LIVING” it with me more so than everyone else, but it would also seem she would have/be more prevalently experienced in this area than all others. I feel as if she’s EMBARRASSED to tell people that I have MS. She was 5 months pregnant with our first little boy in September’12 when I woke up blind, and ever since then she’s acted differently at and towards me. Almost as if I had STOLEN THE SPOTLIGHT from her and her pregnancy, especially when everyone began calling asking how “I” was doing, and not “HER”. Most “MEN” wouldn’t have endured the treatment I have from their own spouses, but I continue to do so. I can’t help it if I “LOVE” her, although I know I can’t MAKE HER love me as well. We now have 2 boys, ages 3 and 5, with whom I stay at home with. I was blessed with very high salaried positions in outside sales which has provided me with a higher than average SSDI monthly payment. I keep the boys, I do all the laundry, I keep the house spotless (people can’t believe 2 toddlers live in my house when they enter it), I pay the mortgage, ALL THE BILLS, buy all groceries, and all clothing needs for my boys. The ONLY THING she provides is working her MINIMUM of 18 to 20 hours per week at Starbucks, simply to maintain benefits/insurance on herself and “ME” (the boys are on Medicaid), yet this still seems to be far too much for her to handle. Anyways, I’ve gotten off on my soapbox and began “VENTING” on here, so I’ll shut up….

    • Jennifer Powell says:

      Hi Robby,

      Thank you so much for sharing what sounds to be a painful situation. Multiple Sclerosis can be extremely hard on the family as a whole. I encourage you to call your local MS Society for local meetings. We all deserve to feel validated in our struggles.

      My heart is with you.

  3. ERIK OXY says:

    Yes l go thru the same thing, with my MS. Mostly when i get excited I start almost to like sobbing or even worse, at a funeral, start laughing or chuckling.Now in the past few few years I am rather mindful and a out those situations. But within the other situations I Wil turn it into a joke. Now sometimes my wife will let me know when I’m inapproprate. Otherwise about 90 % of the time I will make a joke.

    • Jennifer Powell says:

      Hi Erik,

      It is refreshing to hear how you have managed your Pseudobulbar. I also try to joke my way out of otherwise embarrassing circumstances (like tripping and stammering). I will take a page from your book and try it with my Pseudobulbar. Thank you for enlightening myself and others by sharing your coping mechanism.


  4. Janet Perry says:

    I too suffer from PBA, also mild. I thought it was just me, not a part of my MS, even though I knew my brainstem had been affected.

    Happily, my great neurologist suggested a drug, Nuedextra, which is specifically for PBA. It keeps me from all that crying I was doing. It makes me feel more hopeful about my life and my ability to function with MS.

    That, in turn, has given me the emotional stability to work on functioning as well as possible and being thankful for small victories. That change, in turn, has helped me, make more progress.

    I had worried that it was controlling my emotions too much, but that isn’t the case. I can still cry and be upset when life warrants it. I just don’t cry at random not even particularly sad or upsetting things.

    It’s made huge difference in my life.

    • Jennifer Powell says:

      Hi Janet,

      How wonderful that your
      Neurologist identified Pseudobulbar and subsequently treated you. I am encouraged to hear how much it has helped without taking away your natural emotions.

      Thank you for writing and helping myself and many others.


  5. Valerie Webb Suwanseree says:

    Thank you for that, Jennifer. I cry more easily and frequently than before and now I understand it may be partly out of my control. I had never heard of pseudobulbar affect before.

    • Jennifer Powell says:

      Hi Valerie,

      Thank you so much for reading and writing a comment. It helps so much to realize that some of our experiences are indeed side effects of MS.

      Be gentle and kind with yourself. You are never alone.


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