Botulinum toxin A, also known as Botox, could be a welcome wrinkle in the treatment of depression. A new report presented at the annual meeting of the American Psychiatric Association noted that the drug beat placebo in managing this all-too-common condition.
Botox, which is probably best known for its ability to temporarily erase wrinkles from the forehead, seems an unlikely treatment choice for depression. However, according to Ajay Parsaik, MD, of the University of Texas Health Science Center in Houston and one of the study’s authors, extremely small injections of highly poisonous botulinum toxin A were associated with more than four times the chance of remission from depression than was a placebo.
Here’s why researchers believe Botox may be helpful for depression. First, however, you need to understand how botulinum toxin A works.
In order for muscles to contract, your nerves must release acetylcholine, a chemical that bonds to receptors on the muscle cells and allows them to shorten. Botox injections prevent the release of acetylcholine, which in turn stops muscle contractions and the muscles become less stiff, or relaxed.
Researchers now suggest that injecting Botox into the forehead of people who are depressed has a positive impact on facial expression. That is, if you can prevent a depressed or unhappy expression, it may be possible to reduce sadness or depressive mood.
In this new review and meta-analysis, the authors evaluated the findings from studies that looked at the impact of Botox and placebo in individuals with major depressive disorder. Five studies were eligible for the review, and three of them were included in a meta-analysis.
The authors found the following:
- The mean difference in depression scores favored those treated with Botox
- There was more than an eightfold increase in response (at least a 50% improvement in depression scores) among treated versus placebo patients
- There was a 4.6-fold greater chance of remission among Botox patients versus placebo
- Reported side effects were few and included injection site irritation, headache, and vivid dreams
It’s important to note that fewer than 200 patients were involved in the evaluated studies. Larger numbers of subjects need to be studied in future trials.
Another study of Botox and depression
The Journal of Clinical Psychiatry recently published a study in which 30 adults with major depressive disorder were randomly assigned to received either placebo or botulinum toxin A injections in the forehead. The study lasted 24 weeks, and the participants were crossed over a week 12.
Here’s what the authors found:
- In both Botox-treatment groups, participants showed a significant reduction in symptoms of major depressive disorder when compared with placebo. That is, 55% (6 of 11) in the first treatment group and 24% (4 of 17) in the second treatment group responded compared with 0% in the placebo groups.
- Symptom improvement continued beyond the treatment period even though the cosmetic benefits of the drug disappeared at weeks 12 to 16.
- Depression remission rates were 18 percent in both the first and second treatment groups and 0 percent in the placebo groups
The authors concluded that injection of Botox in the forehead “was associated with significant improvement in depressive symptoms and may be a safe and sustainable intervention in the treatment of MDD [major depressive disorder].”
More investigation is needed to validate all of these findings and to determine whether Botox for depression is a feasible treatment option.
Maqid M et al. Treatment of major depressive disorder using botulinum toxin A: a 24-week randomized, double-blind, placebo-controlled study. Journal of Clinical Psychiatry 2014 Aug; 75(8): 837-44
Parsaik AK et al. Role of botulinum toxin in depression: a systemic review and meta-analysis. American Psychiatric Association 2015
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