Actor portrayal of an older female experiencing Pseudobulbar Affect (PBA) crying symptoms Actor portrayal of an older female experiencing Pseudobulbar Affect (PBA) crying symptoms

PBA & depression

Recognizing the
differences between PBA
and depression1-3

Discover how they differ to help you make the right diagnosis

Actor portrayal.

Pseudobulbar Affect (PBA) is commonly comorbid with depression and other mood disorders4,5

57.5%

of patients who were diagnosed with PBA had comorbid depression3*

In a 90-day, open-label, single-arm study, more than half of patients who were diagnosed with PBA had comorbid depression (N=367). 70.8% of patients in the study were taking psychopharmacologic medications.3

*PRISM II was a 90-day, open-label, single-arm, 74-site US trial in adult patients with dementia, stroke, or traumatic brain injury. All patients received a clinical diagnosis of PBA by their healthcare provider and had a Center for Neurologic Study-Lability Scale (CNS-LS) score of ≥13 at baseline. CNS-LS is a self-administered questionnaire, designed to be completed by the patient with a 7-item rating scale that measures perceived frequency and severity of PBA episodes. It was validated as a screening tool in amyotrophic lateral sclerosis and multiple sclerosis populations. A CNS-LS score of ≥13 may suggest but does not confer a PBA diagnosis.3,6

If your patients with depression are still crying, consider asking:

Do you cry sometimes even when you’re not sad?2

Dan, male patient with PBA in his 60s, standing in front of a mountainous landscape Dan, male patient with PBA in his 60s, standing in front of a mountainous landscape
The crying episodes were getting worse and I thought it was part of my depression. I did not know PBA was a completely separate condition.
Dan, Patient living with PBA

Recognize the difference: crying in depression vs crying in PBA

One of the major differences between PBA and depression is the relationship between crying episodes and mood. PBA alters a patient’s expression, or affect, causing involuntary crying that is exaggerated or incongruent with their underlying mood.1-3

If you think your patient may be suffering from PBA, learn more about dosing and treatment with NUEDEXTA.

dosing & treatment

Depression is often comorbid with PBA.4,5 Hear how patients discuss the differences between the two conditions

A white woman with long blonde hair is seen from the waist up, facing the camera. The caption on screen says “Mary Beth, living with PBA.”
  • References: 1.

    Kekere V, Qureshi D, Thanju A, Fouron P, Olupona T. Pseudobulbar affect mimicking depression: a case report. Cureus. 2022;14(6):e26235. doi:10.7759/‌cureus.26235

  • 2.

    Nuedexta. Package insert. Otsuka America Pharmaceutical, Inc.; 2022.

  • 3.

    Hammond FM, Alexander DN, Cutler AJ, et al. PRISM II: an open-label study to assess effectiveness of dextromethorphan/quinidine for pseudobulbar affect in patients with dementia, stroke or traumatic brain injury. BMC Neurol. 2016;16:89. doi:10.1186/‌s12883-016-0609-0

  • 4.

    Brooks BR, Crumpacker D, Fellus J, Kantor D, Kaye RE. PRISM: a novel research tool to assess the prevalence of pseudobulbar affect symptoms across neurological conditions. PLoS One. 2013;8(8):e72232. doi:10.1371/‌journal.pone.0072232

  • 5.

    Miller A, Pratt H, Schiffer RB. Pseudobulbar affect: the spectrum of clinical presentations, etiologies and treatments. Expert Rev Neurother. 2011;11(7):1077-1088. doi:10.1586/‌ern.11.68

  • 6.

    Pioro EP, Brooks BR, Cummings J, et al. Dextromethorphan plus ultra low-dose quinidine reduces pseudobulbar affect. Ann Neurol. 2010;68(5):693-702. doi:10.1002/‌ana.22093

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IMPORTANT SAFETY INFORMATION and INDICATION for NUEDEXTA® (dextromethorphan HBr and quinidine sulfate)

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS:

  • Quinidine and Related Drugs: NUEDEXTA contains quinidine and should not be used concomitantly with other drugs containing quinidine, quinine, or mefloquine.
  • Hypersensitivity: NUEDEXTA is contraindicated in patients with a history of NUEDEXTA-, quinine-, mefloquine-, or quinidine-induced thrombocytopenia, hepatitis, bone-marrow depression, lupus-like syndrome, or known hypersensitivity to dextromethorphan (e.g., rash, hives).
  • MAOIs: NUEDEXTA is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs), or in patients who have taken MAOIs within the preceding 14 days, due to the risk of serious and possibly fatal drug interactions, including serotonin syndrome. Allow at least 14 days after stopping NUEDEXTA before starting an MAOI.
  • Cardiovascular: NUEDEXTA is contraindicated in patients with a prolonged QT interval, congenital long QT syndrome, history suggestive of torsades de pointes, heart failure, patients receiving drugs that both prolong QT interval and are metabolized by CYP2D6 (e.g., thioridazine and pimozide), patients with complete atrioventricular (AV) block without implanted pacemaker, or at high risk of complete AV block.

Thrombocytopenia and Other Hypersensitivity Reactions: Quinidine can cause immune-mediated thrombocytopenia that can be severe or fatal. Non-specific symptoms, such as lightheadedness, chills, fever, nausea, and vomiting, can precede or occur with thrombocytopenia. NUEDEXTA should be discontinued immediately if thrombocytopenia occurs.

Hepatotoxicity: Hepatitis, including granulomatous hepatitis, has been reported in patients receiving quinidine, generally during the first few weeks of therapy. Discontinue immediately if this occurs.

Cardiac Effects: NUEDEXTA causes dose-dependent QTc prolongation. QT prolongation can cause torsades de pointes-type ventricular tachycardia, with the risk increasing as the degree of prolongation increases. When initiating NUEDEXTA in patients at risk for QT prolongation and torsades de pointes, electrocardiographic (ECG) evaluation of QT interval should be conducted at baseline and 3 to 4 hours after the first dose. Some risk factors include use with CYP3A4 inhibitors or drugs that prolong QT interval, electrolyte abnormalities, bradycardia, or left ventricular hypertrophy or dysfunction. If patients taking NUEDEXTA experience symptoms that could indicate the occurrence of cardiac arrhythmias (e.g., syncope or palpitations), NUEDEXTA should be discontinued, and the patient further evaluated.

Concomitant Use of CYP2D6 Substrates: NUEDEXTA inhibits CYP2D6 and may interact with other drugs metabolized by CYP2D6. Adjust dose of CYP2D6 substrates as needed.

Dizziness: NUEDEXTA may cause dizziness. Take precautions to reduce the risk of falls.

Serotonin Syndrome: Use of NUEDEXTA with selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants increases the risk of “serotonin syndrome.”

Anticholinergic Effects of Quinidine: Monitor for worsening in myasthenia gravis.

Adverse Reactions: The most common adverse reactions (incidence of ≥3% and two-fold greater than placebo) in patients taking NUEDEXTA are diarrhea, dizziness, cough, vomiting, asthenia, peripheral edema, urinary tract infection, influenza, increased gamma-glutamyltransferase, and flatulence.

These are not all the risks for use of NUEDEXTA.

To report SUSPECTED ADVERSE REACTIONS, contact Otsuka America Pharmaceutical, Inc. at 1-800-438-9927 or FDA at 1-800-FDA-1088 (www.fda.gov/‌medwatch).

INDICATION

NUEDEXTA is indicated for the treatment of pseudobulbar affect (PBA).

PBA occurs secondary to a variety of otherwise unrelated neurologic conditions, and is characterized by involuntary, sudden, and frequent episodes of laughing and/or crying. PBA episodes typically occur out of proportion or incongruent to the underlying emotional state. PBA is a specific condition, distinct from other types of emotional lability that may occur in patients with neurologic disease or injury.

Please see FULL PRESCRIBING INFORMATION.