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 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 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 Botulinum A toxin 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 Botulinum A toxin 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 Botulinum A toxin 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 Botulinum A toxin 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 Botulinum A toxin treatment could potentially soften the correspondent experience of fear, anger, and sadness  ”.
There would be many potential benefits to using Botulinum A toxin 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.  .
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