Depression affects more than 350 million individuals worldwide and is known to be one of the greatest medical challenges of our time . The current options for the treatment of depression including psychotherapy and pharmacology but these are often ineffective which is why further studies are being carried out to investigate different treatment options.
Jeffrey Borenstein, MD, president and CEO of the Brain and Behavior Research Foundation in New York City, said at the press conference that pursuing new treatments for depression is "crucial."
An emerging novel approach to the treatment of depression is the injection of Botulinum Toxin A (Botox®) into the glabella (frown muscles) of the forehead. This treatment was initially discovered in June 2014 by investigators at the Hannover Medical School in Germany. A total of 30 patients with high levels of chronic and treatment-resistant depression were enrolled in the study. Patients were randomly assigned to receive a single injection of Botulinum Toxin A (Botox®) or a single injection of saline placebo.
Six weeks after a single treatment, the Botox® group had an average 47.1% reduction in symptoms of depression vs. 9.2% in the placebo group. The investigators found that the effect size was even larger at the end of the study.
The study investigators described seeing positive effects on mood in patient’s who had just a single Botox® treatment for the frown lines in the area above the nose and between the eyebrow (Glabella Region).
Study investigator Professor.Tillmann Kruger said at a press conference at the American Psychiatric Association’s 2014 annual meeting, "Our emotions are expressed by facial muscles, which in turn send feedback signals to the brain to reinforce those emotions. Treating facial muscles with Botulinum Toxin A interrupts this cycle”.
A second study by Magid & Kruger et. Al in New York, 2015, conducted 3 independent randomized, controlled trials and consistently showed that a single glabella treatment with Botox® reduces symptoms of depression    .
Treatment of frown lines for cosmetic reasons is an approved indication for Botox® and is the most frequent intervention in aesthetic medicine . “Several studies have shown that this particular cosmetic treatment may exert psychological effects, which may contribute to its popularity     . Those who received Botox® in the forehead reported feeling less depressed, irritable, and anxious, as compared to the control group, despite both groups feeling “equally attractive” after the intervention”. This indicates that Botox® in the forehead has positive mood effects above and beyond the euphoria you would get solely from improved appearance.
The study paper says that; “The mood-lifting effect of such a Botox® treatment may be explained by the facial feedback hypothesis, which dates back to Charles Darwin and William James in the 19th century and has been substantiated in several experimental studies   . In theory, contraction of facial muscles sends a message to the emotional centres of the brain. Smiling can reinforce and maintain feelings of well-being, whereas frowning can lead to the opposite. It is assumed that by paralysing the injected frown muscles interrupts a proprioceptive feedback loop from the face to the emotional brain, therefore reducing the ability to feel negative emotions   . In depression, there is a relative over-activity of frown muscles, which has been confirmed electrophysiologically, and whose elimination by Botox® treatment could potentially soften the correspondent experience of fear, anger, and sadness  ”.
There would be many potential benefits to using Botox® as a treatment for depression. It is a one-off dose and the effect scan last for months. It has an excellent safety and tolerability record and is already approved as a treatment for the glabella frown lines.  .
1.Marcus M, Yasamy MT, van Ommeren M et al. Depression: a global public health concern. World Health Organization (WHO); fact sheet on depression 2012
2.Finzi E, Wasserman E. Treatment of depression with botulinum toxin A: a case series. Dermatol Surg 2006; 32: 645-649 discussion 649–650
3.Wollmer MA, de Boer C, Kalak N et al Facing depression with botulinum toxin: a randomized controlled trial. J Psychiatr Res 2012; 46: 574-581
4.Finzi E, Rosenthal NE. Treatment of depression with onabotulinumtoxinA: a randomized, double-blind, placebo controlled trial. J Psychiatr Res 2014; 52: 1-6
5.Magid MR, Reichenberg JS, Poth PE et al. Treatment of major depressive disorder using botulinum toxin A: a 24-Week randomized, double-blind, placebo-controlled study. J Clin Psychiatry 2014; 75: 837-844
6.Winter L, Spiegel J. Botulinum toxin type-A in the treatment of glabellar lines. Clin Cosmet Investig Dermatol 2009; 3: 1-4
7.Heckmann M, Teichmann B, Schroder U. Pharmacologic denervation of frown muscles enhances baseline expression of happiness and decreases baseline expression of anger, sadness, and fear. J Am Acad Dermatol 2003; 49: 213-216
8.Sommer B, Zschocke I, Bergfeld D et al. Satisfaction of patients after treatment with botulinum toxin for dynamic facial lines. Dermatol Surg 2003; 29: 456-460
9.Lewis MB, Bowler PJ. Botulinum toxin cosmetic therapy correlates with a more positive mood. J Cosmet Dermatol 2009; 8: 24-26
10. Davis JI, Senghas A, Brandt F et al. The effects of BOTOX injections on emotional experience. Emotion 2010; 10: 433-440
11. Havas DA, Glenberg AM, Gutowski KA et al. Cosmetic use of botulinum toxin-a affects processing of emotional language. Psychol Sci 2010; 21: 895-900
Ekman P, Levenson RW, Friesen WV. Autonomic nervous system activity distinguishes among emotions. Science 1983; 221: 1208-1210
12.Adelmann PK, Zajonc RB. Facial efference and the experience of emotion. Annu Rev Psychol 1989; 40: 249-280
13.Larsen RJ, Kasimatis M, Frey K. Facilitating the furrowed brow: an unobtrusive test of the facial feedback hypothesis applied to unpleasant affect. Cogn Emot 1992; 54: 321-338
14.Hennenlotter A, Dresel C, Castrop F et al. The link between facial feedback and neural activity within central circuitries of emotion-new insights from botulinum toxin-induced denervation of frown muscles. Cereb Cortex 2009; 19: 537-542
15.Finzi E. Antidepressant effects of botulinum toxin A: scientific rationale. J Psychiatry Neurosci 2013; 38: E29
16.Finzi E. The face of emotion: How botox affects our moods and relationships. Macmillan; 2013
17.Schwartz GE, Fair PL, Salt P et al. Facial muscle patterning to affective imagery in depressed and nondepressed subjects. Science 1976; 192: 489-491
18. Greden JF, Genero N, Price HL. Agitation-increased electromyogram activity in the corrugator muscle region: a possible explanation of the “Omega sign”?. Am J Psych 1985; 142: 348-351
19. Cavallini M, Cirillo P, Fundarò SP et al. Safety of botulinum toxin A in aesthetic treatments: a systematic review of clinical studies. Dermatol Surg 2014; 40: 525-536
20. Cavallini M, Cirillo P, Fundarò SP et al. Safety of botulinum toxin A in aesthetic treatments: a systematic review of clinical studies. Dermatol Surg 2014; 40: 525-536
21. Young SN. Single treatments that have lasting effects: some thoughts on the antidepressant effects of ketamine and botulinum toxin and the anxiolytic effect of psilocybin. J Psychiatry Neurosci 2013; 38: 78-83