NEW YORK – Botox injections contribute to a strong and sustained alleviation of depression in psychiatric patients, Dr. Tillmann H.C. Krüger and Dr. M. Axel Wollmer reported in a poster presentation at the annual meeting of the American Psychiatric Association.
The finding supports the concept that the facial musculature not only expresses but also regulates mood states, as explained by the facial feedback hypothesis.
In a randomized, double-blind placebo-controlled trial, Dr. Krüger of the Hannover (Germany) Medical School and Dr. Wollmer of Semmelweiss University in Hamburg, Germany, assigned 30 patients with major depression to receive adjuvant treatment in the form of botulinum toxin A (n = 15) or saline injections to the glabellar region of the face.
All patients had previously registered an insufficient response to standard treatments for depression at the time of study enrollment.
The primary endpoint was a change in the 17-item Hamilton Rating Scale for Depression (HAM-D).
After 6 weeks, the investigators found that the HAM-D scores for the Botox patients had dropped by an average of 47.1%, compared with 9.2% for placebo patients (P = .002).
Moreover, the investigators found that the agitation item on the HAM-D was the most accurate predictor of Botox response, with a precision of 78%.
According to the investigators, their finding – originally reported in the Journal of Psychiatric Research (2012;46:574-81) – subsequently has been confirmed in two additional studies this year.
In the first, 74 subjects were randomized to facial injections of onabotulinumtoxinA or placebo; by 6 weeks, decreases of 50% or greater on the Montgomery-Asberg Depression Rating Scale were seen in 52% and 15% of treatment and placebo groups, respectively (J. Psychiatr. Res. 2014;52:1-6).
The second study, also a randomized controlled trial, is still in press. Those findings, along with the others, will be the topic of a forthcoming meta-analysis on the topic of Botox for depression. Dr. Michelle Magid, a psychiatrist at the University of Texas Southwestern–Austin, and Dr. Jason Reichenberg, a dermatologist at the university, reported preliminary findings from that study earlier this year at the annual meeting of the American Academy of Dermatology.
Future research also will address the efficacy of the treatment in other affective and personality disorders, Dr. Krüger and Dr. Wollmer added.
Dr. Krüger and Dr. Wollmer disclosed funding from the Gottfried und Julia Bangerter- Rhyner-Stiftung foundation in Germany, for their current study. Dr. Magid and Dr. Reichenberg are married, and Dr. Magid is a consultant for Allergan.