What is the treatment for Pseudobulbar (Pseudo-Bulbar) affect?

From the Guidelines

Pharmacotherapy, specifically with antidepressants, is the recommended treatment for pseudobulbar affect, as it has been shown to be effective in managing emotional lability. When considering treatment for pseudobulbar affect, it is essential to prioritize the patient's quality of life and minimize the risk of developing clinical depression. According to the evidence provided 1, pharmacotherapy for emotional lability is recommended, with a quality of evidence rated as "Good" and a recommendation grade of "A". Some key points to consider when treating pseudobulbar affect include:

• The use of antidepressants, such as SSRIs or TCAs, has been found to be effective in managing emotional lability 1
• Patient and family education is crucial in managing pseudobulbar affect, as it can help reduce frustration and concern 1
• Treatment should be considered when emotional lability interferes with the patient's rehabilitation or complicates their relationship with family members 1
• The evidence suggests that pharmacotherapy can help reduce the symptoms of pseudobulbar affect and improve the patient's quality of life 1 It is also important to note that pseudobulbar affect can be mistaken for depression, but it is a distinct condition that requires specific treatment. In terms of specific medications, the evidence does not provide a clear recommendation for a particular antidepressant, but it does suggest that pharmacotherapy can be effective in managing emotional lability 1. Overall, the goal of treatment for pseudobulbar affect is to improve the patient's quality of life and reduce the risk of developing clinical depression, and pharmacotherapy with antidepressants is a recommended approach.

From the Research

Pseudobulbar Affect Treatment

• Pseudobulbar affect (PBA) is a dysfunction of emotional expression characterized by involuntary outbursts of crying or laughing disproportionate or unrelated to mood, occurring in patients with various underlying neurologic disorders 2.
• Dextromethorphan/quinidine (DM/Q) is a combination product indicated for the treatment of PBA, with the quinidine component inhibiting the cytochrome P450 2D6-mediated metabolic conversion of dextromethorphan to its active metabolite dextrorphan, thereby increasing dextromethorphan systemic bioavailability 3.

Efficacy of Dextromethorphan/Quinidine

• DM/Q has been shown to be effective in reducing the severity of PBA in patients with amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) 2, 4, 5, 6.
• The efficacy of DM/Q was demonstrated in several large-scale trials, including a 12-week, double-blind, placebo-controlled study in patients with PBA and ALS or MS, which showed a significant decrease in the rate of PBA episodes per day and improvement in PBA severity 2, 4, 6.
• DM/Q was also shown to be effective in improving PBA secondary to dementia in a 12-week noncomparative trial 4.

Safety and Tolerability

• DM/Q was generally well tolerated in clinical trials, with no particular safety or tolerability concerns 2, 4, 6.
• However, some special safety concerns exist with DM/Q, primarily because of the drug interaction and QT prolongation potential of the quinidine component 3.
• The risk of torsade de pointes and drug interactions should be considered when initiating DM/Q treatment, particularly in patients with underlying risk factors and those receiving medications that may interact with DM/Q 3.