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Independents' Day

Patients with depression have impaired sense of humour

Depression is associated with an impaired ability to understand and appreciate humour.

The study recruited 27 inpatients with a diagnosis of major depression and 27 healthy controls, who were asked to complete a computerised task of humour processing.

Participants had to match joke stems with the correct punchline. Cognitive skills thought to be important in understanding humour, such as the ability to infer the beliefs and intentions of others (mentalise) were also assessed.

Patients with depression were significantly more likely to choose the wrong punchline (11.4% and 2.8% incorrect answers respectively, P=<0.05). When they did choose the correct answer, they were less likely to be amused by it (54% compared with 68.8%, P=<0.05).

The impaired humour processing in patients with depression correlated with impaired performance in tests of mentalising and relevant executive cognitive functions. Major depression is associated with dysfunction of the ventromedial prefrontal cortex, which is thought to play an important role in both mentalising and humour appreciation.1

The therapeutic value of humour has been recognised since the 17th century, when Thomas Sydenham famously remarked that ‘The arrival of a good clown exercises a more beneficial influence upon the health of a town than 20 asses laden with drugs.'

Laughter is an effective antidote to stress, promotes a sense of wellbeing, strengthens relationships and may have beneficial effects on immunity and pain tolerance.2 Lack of a sense of humour may increase vulnerability to depression, and loss of the ability to appreciate humour may contribute to the downward spiral of mood in patients with depression.

Humour therapy, in which the therapist tells funny stories or anecdotes to a small group of patients, has been advocated as an additional therapeutic tool in depression. An underpowered pilot study found that inpatients receiving humour therapy in addition to standard care showed greater improvements in quality of life scores than patients receiving standard therapy, but the results were not significant.3

A former colleague of mine used to preface his consultations with a joke or humorous tale. The peals of laughter suggested therapeutic efficacy but, sadly, those patients most likely to benefit from humour may also be those least likely to appreciate it.

Uekermann J, Channon S, Lehmkamper C et al. Executive function, mentalizing and humor in major depression. J Int Neuropsychol Soc 2008;14:55-62


Dr Phillip Bland
GP, Dalton-in-Furness

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