Should doctors medicate people who laugh too much?

I was recently made aware of a new drug “Neurodex” created by Avanir Pharmaceutical to address a newly created disorder called “Involuntary Emotional Expression Disorder” (this is when patients find themselves laughing uncontrollably at something that is only moderately humorous, being unable to stop themselves for several minutes.), and asked what my thoughts about it were.

Involuntary Emotional Expression Disorder is most commonly observed after brain injury, people with dementia expressing a psychosis of some sort, or degeneration in amyotrophic lateral sclerosis (also known as Lou Gehrig disease), a form of motor neuron disease. It affects up to 50% of patients or up to 17,000 people, particularly those with pseudobulbar palsy.[2] It also occurs in approximately 10% of multiple sclerosis patients[3], signalling a degree of cognitive impairment. It is also currently being considered for inclusion in the DSM as one of the two symptoms (of five possible) which must be present for a diagnosis of ADHD in adults. “

Critics may say that this proposed new disorder is one more illustration of how the Diagnostic and Statistical Manual of Mental Disorders (DSM) is primarily driven by the psychopharmacological industry and pathologizes normal behavior, such as grief, sadness, shyness, healthy rebelliousness, and now…laughter.

To be fair it’s also only part of the story as pathological laughter is not “normal”.

From a medical and therapeutic point of view there are 5 main kinds of laughter:

  1. Genuine or spontaneous laughter is unrelated to one’s own free will and triggered by different (external) stimuli and positive emotions. It has been reported that spontaneous laughter causes typical contractions of the muscles around the eye socket (Duchenne laughter/smile).
  2. Self-induced simulated laughter is triggered by oneself at will, with no specific reason (purposeful, unconditional), and therefore not elicited by humor, fun, other stimuli or positive emotions. (i.e. Laughter Yoga techniques, others).
  3. Stimulated laughter happens as a result of the physical action (reflex) of certain external factors (i.e. to be ticklish, specific facial or bodily motions, by pressing laughter bones).
  4. Induced laughter is a result of the effects of specific drugs or substances (i.e. alcohol, caffeine, amphetamines, cannabis, lysergic acid diethylamide or LSD, nitrous oxide or “laughing gas”, and more).
  5. Finally, Pathological laughter is secondary to injuries to the central nervous system caused by various temporary or permanent neurological diseases and may also occur with certain psychiatric disorders. Pathological laughter is developed with no specific stimulus, is not connected with emotional changes, has no voluntary control of its duration, intensity or facial expression, and sometimes comes with “pathological crying”.

What to do if you know people displaying symptoms of pathological laughter? The answer is “I don’t know, ask your doctor.”

I will not take side for 2 main reasons.
(1) I know nothing of and have zero experience in the field of mental health.
(2) It is impossible to give collective answers to personal, specific situations. The only answer there is “it depends.”

While the risk of massive abuse exists with such a drug (e.g., in a mental hospital “Tommy gets on my nerve when he laughs, let’s give him some neurodex to have some peace”), you can reasonably conceive that in some specific cases, say someone with M.S. who wants to socialize yet can’t control their laughter/crying, such a drug can be justified as a short term solution.

I can only pray that the trained medical professionals who will be prescribing Neurodex will do so very wisely.



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