December 2014

Growing Evidence Shows Botox Works for Depression

A single injection of Botox, which is typically used to improve the appearance of facial wrinkles, may be an effective treatment for depression.

Sarah, 47, has struggled with major depression since she was 21 years old. So when Georgetown University asked her to be in a depression study involving Botox, she immediately enrolled. After the first session Sarah felt something she could only describe to her on-line support group as “lighthearted”.  Amazingly, more than half of the study participants, all suffering from major depressive disorder, felt significantly better after a single injection of Botox to the frown lines in the area between the eyebrows. And investigators found that the reduction of depression symptoms was even more profound at the end of the six-week study. In fact, the scores of the Botox recipients on a depression-rating scale were down almost 50 percent, compared to only 20 percent of the control group.

Our emotions are expressed by facial muscles, which in turn send feedback signals to the brain to reinforce those emotions. “I call these facial muscles ‘hot wires’ to the brain,” says Dr. Eric Finzi, a co-investigator of the Georgetown study. “Treating them with Botox interrupts the feedback loop.” A dermatologic surgeon, Frizi grew up carefully monitoring the facial expressions of his mother who suffered from major depression. He always understood the link between the furrowed brow and the onset of a depressive episode. Could we, he wondered, stop depression in its tracks by controlling facial expressions? The preliminary answer is a resounding yes. Rosenthal, the other lead investigator predicts that Botox will become a “standard treatment for depression in the future.”

Like all promising research, experts caution that Botox studies are aiming for a tool to work with traditional treatment, and not to replace therapy, medication and informed life styles. “Depression has always been something that is best treated by a range of things,” says psychiatrist Dr. Amy Wechsler, “but I think Botox may be a powerful new tool in our arsenal.”

At the American Psychiatric Association's 2014 Annual Meeting press conference Jeffrey Borenstein, MD, president and CEO of the Brain and Behavior Research Foundation in New York City commended the Botox research stating the injections hold the promise to be a "novel, effective, well-accepted, and economic therapeutic tool for the treatment of major depression." Botox’s parent company, Allergan, is currently in Phase II clinical trials for its use in treating major depressive disorder. Researchers are also testing Botox’s therapeutic potential in other psychiatric disorders.

Highlighted Studies

Does Ketamine Improve Depressive Symptoms Quickly?
Standard antidepressant medications can take weeks or months to achieve their full effects. Several studies seek to better understand the causes of depression and evaluate the mechanisms in the brain that are related to rapid antidepressant improvement. This study enrolls people experiencing depression between the ages of 18 and 65 (or those with bipolar disorder who are currently in a depressive phase) for an inpatient period of 2- to 3-months. Researchers will evaluate how the experimental medication ketamine, versus placebo, affects glutamate in the brain and whether a rapid reduction of antidepressant symptoms (within hours) can be achieved and sustained. The studies are conducted at the NIH Clinical Center in Bethesda, Maryland.

Detecting Risk of Youth Depression
The Detecting Risk of Youth Depression (DROYD) Project aims to understand the role of stress hormones in adolescents aged 12-16 who have a parent with a history of depression. This study will track stress, depressive symptoms, and related functioning over the course of a year. Participants will be asked to visit the Michigan Psychoneuroendocrinology Laboratory in Ann Arbor, MI twice in one year. Home measures of saliva and hair samples and brief questionnaires will be completed every 3 months.