Laughter therapy in a geriatric patient with treatment-resistant depression and comorbid tardive dyskinesia

To the Editor

Treatment-resistant depression (TRD) in late-life is a challenge for clinicians in terms of medical treatment strategies because there is paucity of evidence-based data to guide second-line or augmentation approaches.

Laughter therapy, including spontaneous laughter and simulated laughter, refers to therapeutic interventions on a group of people to achieve laughter experiences through humor and physical or intellectual activities. Several studies demonstrate the potential benefits of laughter therapy in the elderly with depression (Shahidi et al., 2011). Here is a case of a geriatric patient with TRD and comorbid tardive dyskinesia who achieved sustained remission of her depressive symptoms after laughter therapy.

Mrs N, a 73-year-old retired document delivery woman, developed depression at the age of 59 years. She had failed trials of noradrenaline and specific serotonergic agents, selective serotonin reuptake inhibitors and antipsychotics. The patient also had tardive dyskinesia after taking sulpiride for 5 years. There was no amelioration of the symptoms even after switching the antipsychotic to aripiprazole or quetiapine. The distress of repetitive oral and lingual movements made her increasingly disabled.

In July 2014, the patient attended a laughter therapy club where she received a therapeutic program of a 50-minute session per day, 7 days a week. Each session included a brief talk as mental preparation, simple chants with deep breathing and laughter techniques, as well as physical exercises. The group consisted of 10 participants, and the therapy was performed by a senior member who was certified in the therapeutic program. After 3 months of laughter therapy added to the pharmacological treatment consisting of paroxetine and aripiprazole, Mrs N’s mood dramatically improved and the tardive dyskinesia became less bothersome, albeit the involuntary chewing movements persisted. Currently, she has a positive attitude toward life, without a recurrent depressive episode for more than 1 year.

Since laughter is beneficial to emotional health, there are several potential mechanisms that link laughter with psychological well-being (Beckman et al., 2007; Mora-Ripoll, 2010). Initially, laughter is a psycho-physiological response that leads to both physical and mental relaxation and to positive emotions. Second, laughter may lead to an increased sense of self-efficacy, optimism, resilience and cognitive appraisals, with more effective coping strategies for stress. Third, laughter may increase a person’s relational competencies and interpersonal skills through vicarious experiences with the contagious emotions in a group. Taken together, the aforementioned pathways of laughter may, in turn, generate therapeutic effects for depression.