Simultaneous Laughter and Crying: Pseudobulbar Affect and Other Causes

When Laughter and Tears Occur Together

Involuntary, disproportionate, or context-incongruent laughing and crying is termed pseudobulbar affect (PBA) (also called emotional lability or pathological laughing/crying).

Neurologic Causes

• Stroke (especially bilateral corticobulbar tract lesions).
• Multiple sclerosis.
• ALS, Parkinson's, TBI, brain tumors.
• Dementia (Alzheimer's, vascular).

Psychiatric & Other Causes

• Mood disorders (bipolar, depression with mixed features).
• Medication effects (SSRIs, dopamine agonists, steroids).
• Substance withdrawal.

Distinction from Mood-Congruent Emotion

• PBA: Brief, explosive, untriggered or disproportionate; patient may feel no corresponding emotion.
• Normal: Context-appropriate, sustained, matches subjective feeling.

Treatment

• Dextromethorphan/quinidine (Nuedexta) FDA-approved for PBA.
• SSRIs/TCAs (off-label).
• Treat underlying condition.