Pseudobulbar Affect (PBA) and MS

Medically Reviewed by Christopher Melinosky, MD on September 06, 2022

Pseudobulbar Affect (PBA) is a nervous system condition that makes you suddenly laugh or cry. It can last for seconds or several minutes. Multiple sclerosis (MS) or another neurological disorder is usually what causes it. These affect how your brain controls movement and emotions.

When you have MS, your immune system attacks your central nervous system. That’s what sends signals back and forth between your brain and body. These messages help control how your body functions. MS stops or changes them.

Doctors think PBA is a result. Think of it like this: Your brain gets a fuzzy message full of static that signals your body to react. But the response is uncontrolled and sometimes inappropriate.

The most common symptoms of PBA include:

  • Uncontrolled or sudden outbursts of laughing or crying, usually in response to an emotional event
  • Laughter or crying that doesn’t match the event, or your mood and feelings
  • Laughing or crying for no obvious reason
  • Emotional outbursts that happen more often and are more intense than before
  • Outbursts of anger or frustration


PBA is sometimes mistaken for these conditions:

PBA is often confused with depression because it sometimes involves a lot of crying. But there are key differences between the two conditions. PBA episodes are short. Depression causes overwhelming sadness for a long time. And people with PBA do not have other symptoms linked with depression like insomnia and loss of appetite.

Neurologists (who specialize in the nervous system) and psychiatrists (who specialize in mental health) are two types of doctors who can diagnose PBA. They’ll ask lots of questions during a neurological evaluation. They might also ask you to complete a questionnaire called the Center for Neurological Study-Lability Scale (CNS-LS). It helps you figure out:

  • How often your emotional episodes happen
  • How intense they are
  • Whether they’re appropriate


There’s no cure for PBA, but certain medications can help you manage the condition. They include:

Antidepressants. Even though PBA and depression are different conditions, antidepressants can help with symptoms. People with PBA typically get lower doses than people who have depression.

Nuedexta. This medicine combines a medication typically used as a cough suppressant and a very low dose of a drug used to treat cardiac arrhythmias. It’s the first FDA-approved drug specifically designed to treat PBA.

Show Sources


Multiple Sclerosis Association of America: “Pseudobulbar Affect (PBA).”

Multiple Sclerosis Trust: “Pseudobulbar affect (pathological laughing and crying).”

John Hopkins Medicine: “How the Brain Works,” “Anatomy of the Brain.”

National Multiple Sclerosis Society: “Definition of MS.”

NCH Healthcare System: “Pseudobulbar affect.”

Kids Health: “Your Brain & Nervous System.”

Brain Injury Association of America: “Pseudobulbar Affect (PBA).”

Mayo Clinic: “Pseudobulbar affect,” “Multiple Sclerosis.”

Frontiers in Neurology: “Cerebellar Dysfunction in Multiple Sclerosis.”

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