Off-Label Dextromethorphan/Bupropion for Emotional Lability Following Resection of an IDH-Mutant Astrocytoma: A Case Report.
- 1Department of Behavioral Medicine, West Virginia University School of Medicine, Eastern Campus, Martinsburg, WV 25401, USA.
- 2Department of Hematology and Oncology, West Virginia University School of Medicine, Eastern Campus, Martinsburg, WV 25401, USA.
Abstract
Pseudobulbar affect (PBA) is characterized by recurrent, involuntary episodes of crying or laughing that may be disproportionate or incongruent with an individual's underlying mood. Although dextromethorphan/quinidine is FDA-approved for PBA, clinical experience with dextromethorphan/bupropion for this indication remains limited. We describe a 42-year-old woman with a history of resected right frontal IDH-mutant grade 2 astrocytoma who developed recurrent episodes of involuntary crying associated with emotional lability and subjective executive difficulties. At initial behavioral-health evaluation, the Center for Neurologic Study-Lability Scale (CNS-LS) score was 21/35 and the Patient Health Questionnaire-9 (PHQ-9) score was 9. The phenomenology of the crying episodes, clinical examination, neurological history, imaging surveillance, and consideration of alternative explanations supported a working clinical diagnosis of PBA, although the CNS-LS was used as a symptom measure rather than a stand-alone diagnostic test. Treatment with dextromethorphan/quinidine was associated with an initial reduction in crying episodes and CNS-LS score, followed by recurrence of symptoms. Because further treatment modification was limited by insurance coverage, an off-label trial of dextromethorphan/bupropion was subsequently initiated. Six weeks later, the CNS-LS score had decreased to 10 and the PHQ-9 score to 4. Subjective executive difficulties also improved. A temporary interruption in dextromethorphan/bupropion was followed by recurrence of crying episodes, with improvement after treatment was resumed. This case describes an association between off-label dextromethorphan/bupropion exposure and improvement in emotional-lability symptoms in a patient with a complex neurological and psychiatric presentation. The findings are hypothesis-generating and cannot establish efficacy or causality because of the single-patient design, absence of repeated CNS-LS assessments at all visits, and concomitant medication changes. Controlled studies are needed to determine whether dextromethorphan/bupropion has a therapeutic role in PBA.
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BibTeX
@article{hill2026offlabel,
title = {{Off-Label Dextromethorphan/Bupropion for Emotional Lability Following Resection of an IDH-Mutant Astrocytoma: A Case Report.}},
author = {Olivia Hill and Riley Imlay and Ankit Chalia and Sowjanya Kalluri and Venkata Sugnanam and Michael Ang-Rabanes and Raja Mogallapu},
journal = {Healthcare (Basel, Switzerland)},
year = {2026},
month = oct,
doi = {10.3390/healthcare14203530},
url = {https://europepmc.org/article/MED/42940575},
note = {CC BY},
}
RIS
TY - JOUR
TI - Off-Label Dextromethorphan/Bupropion for Emotional Lability Following Resection of an IDH-Mutant Astrocytoma: A Case Report.
AU - Olivia Hill
AU - Riley Imlay
AU - Ankit Chalia
AU - Sowjanya Kalluri
AU - Venkata Sugnanam
AU - Michael Ang-Rabanes
AU - Raja Mogallapu
PY - 2026
DA - 2026/10/20
JO - Healthcare (Basel, Switzerland)
DO - 10.3390/healthcare14203530
UR - https://europepmc.org/article/MED/42940575
AB - Pseudobulbar affect (PBA) is characterized by recurrent, involuntary episodes of crying or laughing that may be disproportionate or incongruent with an individual's underlying mood. Although dextromethorphan/quinidine is FDA-approved for PBA, clinical experience with dextromethorphan/bupropion for this indication remains limited. We describe a 42-year-old woman with a history of resected right frontal IDH-mutant grade 2 astrocytoma who developed recurrent episodes of involuntary crying associated with emotional lability and subjective executive difficulties. At initial behavioral-health evaluation, the Center for Neurologic Study-Lability Scale (CNS-LS) score was 21/35 and the Patient Health Questionnaire-9 (PHQ-9) score was 9. The phenomenology of the crying episodes, clinical examination, neurological history, imaging surveillance, and consideration of alternative explanations supported a working clinical diagnosis of PBA, although the CNS-LS was used as a symptom measure rather than a stand-alone diagnostic test. Treatment with dextromethorphan/quinidine was associated with an initial reduction in crying episodes and CNS-LS score, followed by recurrence of symptoms. Because further treatment modification was limited by insurance coverage, an off-label trial of dextromethorphan/bupropion was subsequently initiated. Six weeks later, the CNS-LS score had decreased to 10 and the PHQ-9 score to 4. Subjective executive difficulties also improved. A temporary interruption in dextromethorphan/bupropion was followed by recurrence of crying episodes, with improvement after treatment was resumed. This case describes an association between off-label dextromethorphan/bupropion exposure and improvement in emotional-lability symptoms in a patient with a complex neurological and psychiatric presentation. The findings are hypothesis-generating and cannot establish efficacy or causality because of the single-patient design, absence of repeated CNS-LS assessments at all visits, and concomitant medication changes. Controlled studies are needed to determine whether dextromethorphan/bupropion has a therapeutic role in PBA.
SN - 2227-9032
ER -