Depression
Botox Injections Work as Antidepressant
Botulinum toxin A, commonly known as Botox, may be more than an anti-aging treatment. A new study has found that when Botox is injected between the eyebrows, it not only has a cosmetic effect—it also yields a long-lasting antidepressant effect.
Researchers at the University of Texas Southwestern in Austin conducted a 24-week randomized, double-blind, placebo-controlled study including 30 participants with major depressive disorder (MDD). Patients taking antidepressants were included in the study, but researchers excluded anyone taking more than three psychotropic drugs, who had an Axis II diagnosis, or who were “overly invested in cosmetic treatments,” although this was not defined further.
Participants were randomly assigned to receive either a single Botox injection or placebo into the glabellar muscles that cause frown lines. At week 12, those who received placebo were given the Botox treatment, and the Botox group crossed over to receive placebo.
Researchers evaluated the participants at weeks 0, 3, 6, 12, 15, 18, and 24 for improvement in MDD symptoms using the Patient Health Care Questionnaire-9 (PHQ- 9), Beck Depression Inventory (BDI), and 21-Item Hamilton Depression Rating Scale (HDRS-21). The primary outcome was antidepressant response as defined by a reduction of at least 50% on the Hamilton scale. Partial response was defined as a 25% to 49% reduction.
Patients who received Botox (either at week 0 or at week 12) had a statistically significant reduction in MDD symptoms, compared to those receiving placebo. Six weeks after receiving Botox, response rates were 55% in the group that received the injection at week 0, 24% in the group that received the injection at week 12, and 0% in the placebo group. Partial responses were seen in 73%, 65%, and 5%, respectively. Surprisingly, symptoms continued to decrease over the 24-week period after a single Botox injection, even though the cosmetic effects wore off in 12 to 16 weeks.
What’s behind the improvement? Nobody knows for sure, but researchers speculate that it may be due to its cosmetic effect, more positive social feedback to a happier face, or decreased feedback from the facial muscles to the brain resulting in less activation of the amygdala and other structures involved in depression (Magid M et al, J Clin Psychiatry 20l4;75(8);837-844).
This article originally appeared in The Carlat Psychiatry Report -- an unbiased monthly covering all things psychiatry.
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TCPR’s Take: This study lends preliminary support to the idea that looking happier might make a patient feel happier, too. While the sample size was small and 93% of participants were women, the impressive response rates argue that Botox might someday be employed as a safe and effective antidepressant strategy.
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