How is pseudobulbar affect (PBA) treated?
There is no cure for pseudobulbar affect (PBA), although the condition can be managed with oral medications.
The goal of treatment is to reduce the frequency and severity of episodes of laughing or crying. Drugs that are used to treat PBA include:
- Antidepressants. Tricyclic antidepressants (amitriptyline, nortriptyline), selective serotonin reuptake inhibitors (citalopram, fluoxetine, sertraline, fluvoxamine), and norepinephrine/serotonin reuptake inhibitors (venlafaxine, duloxetine and others) may be effective in managing symptoms. Lower doses of antidepressants are used than the doses required to treat depression, and are effective much quicker than expected when treating depression.
- Nuedexta® (dextromethorphan/quinidine sulfate). A combination of dextromethorphan, a cough suppressant, and a very low dose of quinidine sulfate, a drug used in the past to treat cardiac arrhythmias, has been approved as the first drug specifically developed to treat PBA. Although improvement in symptoms usually occurs within the first week of starting treatment (when taking only one capsule daily), a greater benefit occurs when taking the full dose (two capsules daily), and continues with no evidence of losing efficacy.
- Other medications. Other drugs may be used for patients who do not respond to first-line treatments.
The choice of medication depend on the patient’s tolerance and the potential side effects or adverse effects of the drug. Some medications may interact with the drugs prescribed for other conditions, and this needs to be watched for.