Uncontrollable Laughing or Crying
Derek cries all the time. When entertainers visit his nursing home, Derek weeps while other residents are laughing and clapping. Offer Derek a delicious dessert and he will cry. Congratulate him on the success of his grandchild, who he dearly loves, and Derek will burst into tears. Others don't know how to respond to Derek, so they tend to avoid him whenever possible.
In Derek's case, when he is enjoying himself or happy, he often experiences outbursts of crying. At one time it was suggested that Derek might even be bi-polar. While he is not bi-polar, Derek is beginning to suffer from depression caused by being socially uncomfortable.
Derek is aware what is happening, but he is powerless to control his involuntary crying. His embarrassment has caused him to avoid being around other people whenever he can to avoid their stares and his own discomfort. While he still eats in the dining room, he now prefers to sit alone, and he rarely joins in during activities. This is a shame, because Derek is still an intelligent man.
The truth is, Derek has sustained some damage to the part of his brain that governs how he expresses emotion. When he is feeling joyful or upbeat, a "short circuit" in his brain responds with crying and tears. Most of the time the emotion that Derek displays is not what he is really feeling. This can be just as upsetting to Derek as it is to his family and others.
Derek has a condition called pseudobulbar affect (PBA). A significant number of people with certain neurological disorders experience PBA, which is characterized by uncontrollable laughing or crying that may be totally unrelated to what they are actually feeling or to the situation.
Somewhere between 10% and 50% of individuals with Alzheimer's Disease, Parkinson's Disease, multiple sclerosis, amyotrophic lateral sclerosis (ALS), or traumatic brain injury also suffer the outbursts of laughing or crying that are symptoms of PBA.
Pseudobulbar affect is best diagnosed by a neurologist or a psychiatrist. Indeed, many general practitioners are confused by the symptoms and diagnose depression or another psychiatric condition. While depression may be a consequence of PBA, the underlying condition is not psychiatric, but a side effect of neurological damage.
There is currently no approved treatment for PBA. Some physicians are trying off-label combinations of antidepressant and anti-psychotic medications, with mixed results.
The PBAInfo.org website suggests the following steps that someone with PBA can try when they feel an uncontrollable emotional episode beginning:
• Be open about it. Warn people that you cannot always control your emotions. Explain that the emotions you show on the outside don't always reflect how you feel on the inside.
• Distract yourself. If you feel an emotional episode coming on, try to focus on something unrelated.
• Note the posture you take when crying. When you think you are about to cry, change your posture.
• Breathe in and out slowly until you are in control.
• Relax your forehead, shoulders and other muscle groups that tense up during an emotional episode.
Avanir Pharmaceuticals is currently conducting trials of an investigational drug which combines dextromethorphan and low-dose quinidine. This drug, Zenvia™, has shown some promise in reducing the incidence and severity of PBA and improving quality of life. Early participants in these studies have seen measurable improvements in symptoms.
People who are experiencing the effects of PBA and who would like to participate in the ongoing trials can find more information about the pseudobulbar affect research studies of Zenvia™and how to participate at the Avenir Pharmaceuticals website.