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Treatment of Depression with Facial Injections of Botulinum Toxin

2014-09-01

Here’s a report about a small study, with about 40 patients in each arm, that shows a fifty percent response of major depression to injections of botulinum toxin A into the areas that control frowning: http://www.empr.com/turning-the-frown-upside-down-using-botulinum-toxin-to-treat-depression/article/329524/  The original study was e-published in the Journal of Psychiatric Research December 1, 2013.

The study, which is written up here on January 21, 2014, on the pharmaceutical website MPR, was done with the hypothesis that inhibiting corrugator and procerus muscle activity with botulinum toxin would ease depressive symptoms (where they got this cart before the horse idea, it doesn’t say) and got a 52 percent response from active injections with only 15 percent response to placebo injections.  A single injection, six weeks before evaluation, was effective with a p of less than 0.001.  Remission rates were also highly significant.  What’s more, when shown photographs of the subjects, observers were able to correctly infer whether the subject had received active treatment three-quarters of the time.  Those who responded also had durable responses if injections were given every three months.

The authors of the study described this effect as “emotional proprioception.”  They theorized that tension in the affected muscles forms part of a feedback system that affects mood.  It is also possible that one’s appearance of happiness to others (or even in the mirror) may have a positive effect on one’s mood.  Some studies even show that voluntarily contracting one’s face into a smile or a frown seems to stimulate the related mood in the subject.  Studies of depressed patient’s corrugator muscle activity showed that it was spontaneously higher than normal and did not respond normally (by relaxation) to viewing a happy picture.  Conversely, normal subjects had increases in corrugator contraction and dysphoric moods when shown unhappy pictures, which were reversed by viewing happy pictures.

Pharmacotherapy is known to have a failure rate of about 30%, even when multiple drugs are tried.  So a 50% response rate for such a relatively safe, single dose treatment is pretty good.  Why it would work is a matter of speculation, but it’s certainly very interesting.  Another unexpected beneficial effect of botulinum toxin is the relief of migraine headaches; why inhibition of muscle contractions would relieve migraines is another highly speculative area.

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