Botox Injections May Be Useful for Major Depression

Laurie Barclay, MD

May 16, 2006

May 16, 2006 — Botulinum toxin A injections can treat major depression, according to the results of a small case series reported in the May issue of Dermatologic Surgery.

"Major depression is a common and serious disease that may be resistant to routine pharmacologic and psychotherapeutic treatment approaches," write Eric Finzi, MD, PhD, and Erik A. Wasserman, PhD, from Dermatology and Cosmetic Surgery Associates in Greenbelt, Maryland, and Chevy Chase Cosmetic Center in Maryland. "There is a body of evidence that suggests that the facial expression of emotion may play a causal role in the subjective experience of emotion. We initiated a small open pilot trial to determine whether inhibiting the expression of facial frowning commonly associated with depression could help ameliorate depressive symptoms."

A total of 10 patients who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for ongoing major depression refractory to pharmacologic or psychotherapeutic treatment were evaluated with the Beck Depression Inventory II (BDI-II) before receiving botulinum toxin A to their glabellar frown lines.

Two months later, all patients were reevaluated clinically and with the BDI-II. Nine of 10 patients were no longer depressed, and the 10th patient had an improvement in mood.

"These findings are very promising and show that Botox has the ability to work in ways we don't expect," Alastair Carruthers, MD, president-elect of the American Society for Dermatologic Surgery and head of Carruthers Dermatology in Vancouver, British Columbia, Canada, says in a news release. "It's encouraging that these preliminary results lay the ground work for larger scale studies to be conducted to define a possible role for Botox in the treatment of depression."

Dr. Finzi has applied for a patent using botulinum toxin A to treat depression.

In an accompanying commentary, Dr. Carruthers and Marilynn Hammond, MD, from Daphne, Alabama, call this report "intriguing," but note that the report must be considered anecdotal because there were no appropriate controls. Other methodological weaknesses including limited follow-up, lack of randomization, the absence of blind evaluation, the small number of individuals studied, and self-report of depressive symptoms with potential for secondary gain.

"Previous research conducted by Charles Darwin suggested that facial muscle and skin movement may contribute to our moods and emotions," Dr. Carruthers says. "Therefore, by relaxing those muscles it is possible to alleviate depressive disorders."

However, Dr. Carruthers notes that patients treated with Botox for depression should be evaluated differently than those using Botox for cosmetic purposes. "While typically Botox should be administered every four to six months to maintain a youthful appearance, patients utilizing it for a medicinal purpose should work with their doctor to monitor their symptoms of depression," he says. "Once those symptoms begin to increase, treatment with Botox should be administered."

Dermatologic Surg. 2006;32:645-650

Reviewed by Gary D. Vogin, MD