Facing depression with botulinum toxin: A randomized controlled trial

Psychiatric Hospital of the University of Basel, Wilhelm-Klein-Str 27, 4012 Basel, Switzerland.
Journal of Psychiatric Research (Impact Factor: 3.96). 02/2012; 46(5):574-81. DOI: 10.1016/j.jpsychires.2012.01.027
Source: PubMed


Positive effects on mood have been observed in subjects who underwent treatment of glabellar frown lines with botulinum toxin and, in an open case series, depression remitted or improved after such treatment. Using a randomized double-blind placebo-controlled trial design we assessed botulinum toxin injection to the glabellar region as an adjunctive treatment of major depression. Thirty patients were randomly assigned to a verum (onabotulinumtoxinA, n = 15) or placebo (saline, n = 15) group. The primary end point was change in the 17-item version of the Hamilton Depression Rating Scale six weeks after treatment compared to baseline. The verum and the placebo groups did not differ significantly in any of the collected baseline characteristics. Throughout the sixteen-week follow-up period there was a significant improvement in depressive symptoms in the verum group compared to the placebo group as measured by the Hamilton Depression Rating Scale (F((6,168)) = 5.76, p < 0.001, η(2) = 0.17). Six weeks after a single treatment scores of onabotulinumtoxinA recipients were reduced on average by 47.1% and by 9.2% in placebo-treated participants (F((1,28)) = 12.30, p = 0.002, η(2) = 0.31, d = 1.28). The effect size was even larger at the end of the study (d = 1.80). Treatment-dependent clinical improvement was also reflected in the Beck Depression Inventory, and in the Clinical Global Impressions Scale. This study shows that a single treatment of the glabellar region with botulinum toxin may shortly accomplish a strong and sustained alleviation of depression in patients, who did not improve sufficiently on previous medication. It supports the concept, that the facial musculature not only expresses, but also regulates mood states.

Download full-text


Available from: Nadeem Kalak
  • Source
    • "The effects of BOTOX injections are not merely cosmetic; such interventions may also restrain facial movements, thereby reducing a person's ability to accurately simulate the perceived emotion in the self, interpret others' emotional facial expressions (e.g., Hennenlotter et al., 2009; Neal & Chartrand, 2011), and process emotional language (Havas, Glenberg, Gutowski, Lucarelli, & Davidson, 2010). On the other hand, BOTOX injections in the glabellar region can also improve mood (Lewis & Bowler, 2009) and even reduce the symptoms of major depression (Wollmer et al., 2012), confirming the key role played by facial expressions in emotional experience. The relationship between facial activity and the corresponding experience of emotion is particularly important for preverbal infants, because they rely on facial expressions of caretakers for behavioral regulation and "
    [Show abstract] [Hide abstract]
    ABSTRACT: Research shows that pacifiers disrupt infants’ mimicry of facial expressions. This experiment examines whether pacifiers interfere with caretakers’ ability to mimic infants’ emotions. Adults saw photographs of infants with or without a pacifier. When infants had pacifiers, perceivers showed reduced EMG activity to infants’ smiles. Smiles of infants using a pacifier were also rated as less happy than smiles depicted without a pacifier. The same pattern was observed for expressions of distress: adults rated infants presented with pacifiers as less sad than infants without pacifiers. We discuss deleterious effects of pacifier use for the perceiver’s resonance with a child’s emotions.
    Full-text · Article · Jul 2014 · Basic and Applied Social Psychology
  • Source
    • "This indicates that such understanding normally affords a slight frowning movement. On the other hand, injection of botulinum toxin into these muscles may significantly improve depressive symptoms in patients as has been shown in a randomized controlled trial by Wollmer et al. (2012). Obviously, negative evaluation of oneself as well as of semantic content is supported by corresponding facial expressions. "
    [Show abstract] [Hide abstract]
    ABSTRACT: There is a growing body of research indicating that bodily sensation and behavior strongly influences one's emotional reaction toward certain situations or objects. On this background, a framework model of embodied affectivity 1 is suggested: we regard emotions as resulting from the circular interaction between affective qualities or affordances in the environment and the subject's bodily resonance, be it in the form of sensations, postures, expressive movements or movement tendencies. Motion and emotion are thus intrinsically connected: one is moved by movement (perception; impression; affection 2) and moved to move (action; expression; e-motion). Through its resonance, the body functions as a medium of emotional perception: it colors or charges self-experience and the environment with affective valences while it remains itself in the background of one's own awareness. This model is then applied to emotional social understanding or interaffectivity which is regarded as an intertwinement of two cycles of embodied affectivity, thus continuously modifying each partner's affective affordances and bodily resonance. We conclude with considerations of how embodied affectivity is altered in psychopathology and can be addressed in psychotherapy of the embodied self.
    Full-text · Article · Jun 2014 · Frontiers in Psychology
  • Source
    • "All 10 participants in an open case study experienced remission of depression or at least marked reduction in its symptoms (3). Subsequently, in the first randomized, controlled trial (RCT) we showed that a single treatment of the glabellar region with onabotulinumtoxinA may lead to a strong and sustained alleviation of major depression symptoms that had not improved sufficiently through previous antidepressant medication and these findings were confirmed in two other RCTs (4–6). Improvement in the symptoms of depression was also observed in a recent open study (7). "
    [Show abstract] [Hide abstract]
    ABSTRACT: In a randomized, controlled trial (n = 30), we showed that botulinum toxin injection to the glabellar region produces a marked improvement in the symptoms of major depression. We hypothesized that the mood-lifting effect was mediated by facial feedback mechanisms. Here we assessed if agitation, which may be associated with increased dynamic psychomotor activity of the facial musculature, can predict response to the treatment. To test this hypothesis, we re-analyzed the data of the scales from our previous study on a single item basis and compared the baseline scores in the agitation item (item 9) of the Hamilton Depression Rating Scale (HAM-D) between responders (n = 9) and participants who did not attain response (n = 6) among the recipients of onabotulinumtoxinA (n = 15). Responders had significantly higher item 9 scores at baseline [1.56 + 0.88 vs. 0.33 + 0.52, t (13) = 3.04, d = 1.7, p = 0.01], while no other single item of the HAM-D or the Beck Depression Inventory was associated with treatment response. The agitation score had an overall precision of 78% in predicting response in a receiver operating characteristic (ROC) analysis (area under the curve, AUC = 0.87). These data provide a link between response to botulinum toxin treatment with a psychomotor manifestation of depression and thereby indirect support of the proposed facial feedback mechanism of action. Moreover, it suggests that patients with agitated depression may particularly benefit from botulinum toxin treatment.
    Full-text · Article · Mar 2014 · Frontiers in Psychiatry
Show more