Pharmacopsychiatry 2015; 48(06): 205-210
DOI: 10.1055/s-0035-1559621
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Treating Depression with Botulinum Toxin: A Pooled Analysis of Randomized Controlled Trials

M. Magid*
1   Department of Psychiatry, University of Texas at Austin, Dell Medical School, Austin, TX, USA (MM)
,
E. Finzi*
2   Department of Psychiatry, George Washington School of Medicine, USA
,
T. H. C. Kruger*
3   Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Germany (THCK, SJ)
,
H. T. Robertson
4   Department of Analytics, Seton Family of Hospitals, Austin, TX, USA (HR)
,
B. H. Keeling
5   Department of Dermatology, University of Texas at Austin, Dell Medical School, Austin, TX, USA (BHK, JSR)
,
S. Jung
3   Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Germany (THCK, SJ)
8   Asklepios Clinic North – Ochsenzoll, Asklepios Campus Hamburg, Medical Faculty, Semmelweis University, Germany (SJ, MAW)
,
J. S. Reichenberg
5   Department of Dermatology, University of Texas at Austin, Dell Medical School, Austin, TX, USA (BHK, JSR)
,
N. E. Rosenthal
6   Capital Clinical Research Associates, Rockville, MD, USA (NER)
7   Georgetown Medical School, Washington, DC, USA (NER)
,
M. A. Wollmer
8   Asklepios Clinic North – Ochsenzoll, Asklepios Campus Hamburg, Medical Faculty, Semmelweis University, Germany (SJ, MAW)
9   Psychiatric Clinics of the University of Basel, Switzerland (MAW)
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received 26. Mai 2015
revised 15. Juli 2015

accepted 16. Juli 2015

Publikationsdatum:
07. August 2015 (online)

Abstract

Introduction: Botulinum toxin A (BTA) injection into the glabellar region is currently being studied as a treatment for major depressive disorder (MDD). Here we explore efficacy data of this novel approach in a pooled analysis.

Methods: A literature search revealed 3 RCTs on this topic. Individual patient data and clinical end points shared by these 3 trials were pooled and analyzed as one study (n=134) using multiple regression models with random effects.

Results: In the pooled sample, the BTA (n=59) and the placebo group (n=75) did not differ in the baseline variables. Efficacy outcomes revealed BTA superiority over placebo: Improvement in the Hamilton Depression Rating Scale or Montgomery-Asberg Depression Rating Scale 6 weeks after baseline was 45.7% for BTA vs. 14.6% for placebo (p<0.0001), corresponding to a BTA response rate of 54.2% (vs. 10.7%) and a BTA remission rate of 30.5% (vs. 6.7%).

Discussion: Equalling the status of a meta-analysis, this study increases evidence that a single treatment of BTA into the glabellar region can reduce symptoms of MDD. Further studies are needed to better understand how BTA exerts its mood-lifting effect.

* Equal contribution.


Supporting Information

 
  • References

  • 1 Marcus M, Yasamy MT, van Ommeren M et al. Depression: a global public health concern. World Health Organization (WHO); fact sheet on depression 2012
  • 2 Finzi E, Wasserman E. Treatment of depression with botulinum toxin A: a case series. Dermatol Surg 2006; 32: 645-649 discussion 649–650
  • 3 Wollmer MA, de Boer C, Kalak N et al Facing depression with botulinum toxin: a randomized controlled trial. J Psychiatr Res 2012; 46: 574-581
  • 4 Finzi E, Rosenthal NE. Treatment of depression with onabotulinumtoxinA: a randomized, double-blind, placebo controlled trial. J Psychiatr Res 2014; 52: 1-6
  • 5 Magid MR, Reichenberg JS, Poth PE et al. Treatment of major depressive disorder using botulinum toxin A: a 24-Week randomized, double-blind, placebo-controlled study. J Clin Psychiatry 2014; 75: 837-844
  • 6 Winter L, Spiegel J. Botulinum toxin type-A in the treatment of glabellar lines. Clin Cosmet Investig Dermatol 2009; 3: 1-4
  • 7 Heckmann M, Teichmann B, Schroder U. Pharmacologic denervation of frown muscles enhances baseline expression of happiness and decreases baseline expression of anger, sadness, and fear. J Am Acad Dermatol 2003; 49: 213-216
  • 8 Sommer B, Zschocke I, Bergfeld D et al. Satisfaction of patients after treatment with botulinum toxin for dynamic facial lines. Dermatol Surg 2003; 29: 456-460
  • 9 Lewis MB, Bowler PJ. Botulinum toxin cosmetic therapy correlates with a more positive mood. J Cosmet Dermatol 2009; 8: 24-26
  • 10 Davis JI, Senghas A, Brandt F et al. The effects of BOTOX injections on emotional experience. Emotion 2010; 10: 433-440
  • 11 Havas DA, Glenberg AM, Gutowski KA et al. Cosmetic use of botulinum toxin-a affects processing of emotional language. Psychol Sci 2010; 21: 895-900
  • 12 Ekman P, Levenson RW, Friesen WV. Autonomic nervous system activity distinguishes among emotions. Science 1983; 221: 1208-1210
  • 13 Adelmann PK, Zajonc RB. Facial efference and the experience of emotion. Annu Rev Psychol 1989; 40: 249-280
  • 14 Larsen RJ, Kasimatis M, Frey K. Facilitating the furrowed brow: an unobtrusive test of the facial feedback hypothesis applied to unpleasant affect. Cogn Emot 1992; 54: 321-338
  • 15 Hennenlotter A, Dresel C, Castrop F et al. The link between facial feedback and neural activity within central circuitries of emotion-new insights from botulinum toxin-induced denervation of frown muscles. Cereb Cortex 2009; 19: 537-542
  • 16 Finzi E. Antidepressant effects of botulinum toxin A: scientific rationale. J Psychiatry Neurosci 2013; 38: E29
  • 17 Finzi E. The face of emotion: How botox affects our moods and relationships. Macmillan; 2013
  • 18 Schwartz GE, Fair PL, Salt P et al. Facial muscle patterning to affective imagery in depressed and nondepressed subjects. Science 1976; 192: 489-491
  • 19 Greden JF, Genero N, Price HL. Agitation-increased electromyogram activity in the corrugator muscle region: a possible explanation of the “Omega sign”?. Am J Psych 1985; 142: 348-351
  • 20 Zimmerman M, Posternak MA, Chelminski I. Derivation of a definition of remission on the Montgomery-Asberg depression rating scale corresponding to the definition of remission on the Hamilton rating scale for depression. J Psychiatr Res 2004; 38: 577-582
  • 21 Wang YP, Gorenstein C. Psychometric properties of the Beck Depression Inventory-II: a comprehensive review. Rev Bras Psiquiatr 2013; 35: 416-431
  • 22 Honeck P, Weiss C, Sterry W et al Reproducibility of a four-point clinical severity score for glabellar frown lines. Br J Dermatol 2003; 149: 306-310
  • 23 Brin MF, Boodhoo TI, Pogoda JM et al. Safety and tolerability of onabotulinumtoxinA in the treatment of facial lines: a meta-analysis of individual patient data from global clinical registration studies in 1678 participants. J Am Acad Dermatol 2009; 61: 961-970.e1–11
  • 24 Cavallini M, Cirillo P, Fundarò SP et al. Safety of botulinum toxin A in aesthetic treatments: a systematic review of clinical studies. Dermatol Surg 2014; 40: 525-536
  • 25 Durham PL, Cady R. Insights into the mechanism of onabotulinumtoxinA in chronic migraine. Headache: The Journal of Head and Face Pain 2011; 51: 1573-1577
  • 26 Mazzocchio R, Caleo M. More than at the neuromuscular synapse: actions of botulinum neurotoxin A in the central nervous system. Neuroscientist 2015; 21: 44-61
  • 27 Young SN. Single treatments that have lasting effects: some thoughts on the antidepressant effects of ketamine and botulinum toxin and the anxiolytic effect of psilocybin. J Psychiatry Neurosci 2013; 38: 78-83
  • 28 Beer K. Cost effectiveness of botulinum toxins for the treatment of depression: preliminary observations. J Drugs Dermatol 2010; 9: 27-30
  • 29 Perlis RH, Ostacher M, Fava M et al Assuring that double-blind is blind. Am J Psych 2010; 167: 250-252
  • 30 Walsh BT, Seidman SN, Sysko R et al. Placebo response in studies of major depression: variable, substantial, and growing. JAMA 2002; 287: 1840-1847
  • 31 Brown WA, Johnson MF, Chen MG. Clinical features of depressed patients who do and do not improve with placebo. Psychiatry Res 1992; 41: 203-214
  • 32 Wollmer MA, Kalak N, Jung S et al Agitation predicts response of depression to botulinum toxin treatment in a randomized controlled trial. Front Psychiatry 2014; 5: 36