”Tears- Crying For No Reason”


”When a father gives to his son, both laugh; when a son gives to his father, both cry”.

As men age, we’re more prone to — and able to — express our pain and connect to our emotions. That’s not weakness, it’s hope.

I begin many days by crying. I’m not depressed, it’s not something I intend to do and I’m not a sad person. It just happens, often when I’m reading the morning paper. And it’s been going on for several years. A patient comes to a psychiatrist because he’s having sudden bouts of crying for no apparent reason. The doctor diagnoses depression and prescribes an antidepressant. The patient’s crying episodes are reduced, but there is still a problem.

In both cases, the diagnosis may be correct, but the reason for these bursts of uncontrollable crying and, less often, laughing may be due to an illness called pseudobulbar affect (PBA). (The illness may be known by several names, and more recently has been called involuntary emotional expression disorder, or IEED.)

What Is PBA?

The main symptom of PBA is sudden, unexplained and unstoppable crying that occurs multiple times a day for no apparent reason. Similar sudden laughing can also occur, as well as bursts of anger. Very often, patients become socially isolated out of embarrassment, which can lead to other depressive symptoms.

Pseudobulbar affect is a condition that occurs due to other neurologic conditions and may occur in patients with amyotrophic lateral sclerosis (ALS or Lou Gehrig’s Disease), multiple sclerosis (MS), Alzheimer’s disease, and Parkinson’s disease. Traumatic brain injury via accident or stroke may cause PBA to appear as well. Sometimes PBA symptoms uncover a hidden brain injury.
A major study found that 51% of people with PBA reported spending little to no time with friends and family, and 57% little to no time talking on the telephone. Thus the impact on daily life and functioning of this illness is extreme.

Differences Between PBA and Mood Disorders

The primary difference between pseudobulbar affect and other mental illnesses like depression and bipolar are that the outbursts of crying, laughing and/or anger happen for no reason, last a very short time, and can occur many times in the course of a day. Still, one can see where a patient who only has bouts of crying might be diagnosed with depression, especially since one study found that almost 90 percent of PBA patients also had significant depressive symptoms.

Since social withdrawal/isolation is so often a symptom of major depressive episodes, the reason for it has to be determined. In depression and bipolar disorder, this is a primary symptom, while in PBA, it happens because patients are fearful of being in social situations. Imagine bursting out laughing during a funeral, or suddenly crying in the middle of a board meeting. Such events could easily make a person avoid any situation where PBA symptoms would be inappropriate and embarrassing.
Some symptoms of depressive episodes aren’t associated with PBA, such as changes in appetite and inappropriate feelings of hopelessness or guilt.


It’s only recently that a treatment specifically for PBA was found, and then only by accident. Researchers were testing a combination of two drugs to see if it helped symptoms of ALS, and although there was no effect on ALS, those patients who had PBA reported that the experimental treatment decreased their laughing and/or crying.

The combination consists of dextromethorphan and quinidine, a heart medication. Although dextromethorphan is a common ingredient in cough medicines, patients should not try to self-medicate for PBA, as the prescription medication is quite different.

More research is needed to determine whether the drug is safe for people with disorders like Parkinson’s disease. There are concerns about problems arising from mixing it with medications for these illnesses. In addition, patients taking antidepressants that act on serotonin, or those with any risk of heart rhythm problems, need particular cautions.


Diagnosis or Misdiagnosis?

Some reliable tests for PBA have been developed, and more are in the works. Because so many people are misdiagnosed as having depression, bipolar, or other illnesses such as anxiety disorders or even schizophrenia, it’s impossible to know how many people in the U.S. actually have pseudobulbar affect. Estimates put the number of patients with PBA between one and two million. With time and education, more people will be identified as having PBA and have access to proper treatment.

At last, Perhaps social scientists will eventually find a way to exhaustively quantify the changes. Right now, though, it’s important simply to know what I and other men are seeing and feeling. We are more willing to admit to and feel the terrible pain of our losses; to weep in celebration of our own and other’s loving connections; to know and feel the threat that individual and collective greed and selfishness, and the fear that feeds them, pose to all of us and to generations beyond us. That our tender emotions are hopeful signs, not of weakness or pathology, but of a necessary and welcome growth — in our compassion, wholeness and, perhaps, our wisdom.

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