Botox battles clinical depression?

Chevy Chase, Md. — A small open pilot trial involving Botox (botulinum toxin A, Allergan) injected into glabellar lines shows this treatment appears to banish major clinical depression.

Dr. Hirsch

For the study, researchers selected 10 patients who had never before received botulinum toxin injections, and who met DSM-IV criteria for ongoing major depression despite pharmacologic or psychotherapeutic treatment. After evaluation with the Beck Depression Inventory II (BDI-II), patients were injected with 29 units of botulinum toxin A into the procerus and corrugator supercilii muscles.

'Interrupted link'

Two months post-treatment, nine patients no longer suffered from depression, according to pre-treatment evaluation tools (Finzi E, Wasserman E. Dermatol Surg. 2006;32:645-650).

Researchers followed some patients for up to 1.5 years after the study ended and found that occasional retreatment had a similar effect, says Eric Finzi, M.D., Ph.D., a Chevy Chase, Md.-based dermatologic surgeon in private practice and the study's lead author.

Dr. Beer

Researchers make no claim of understanding depression based on their findings, he says. Rather, Dr. Finzi tells Cosmetic Surgery Times that the treatment "interrupted a link in the chain of depression."

"There's quite a bit of psychiatric literature showing that the facial expressions are part and parcel of the emotion, not just a consequence," he says.

Dr. Finzi, who is also an artist, says he began discovering this literature — which includes the work of Charles Darwin — while working on paintings of mental patients based on photos from the 1880s.

"My interpretation of all the data was that one actually must show the expression on one's face to feel it, to some extent," he says.

Cautious optimism

The trial has elicited cautious optimism from most experts contacted by Cosmetic Surgery Times.

Dr. Tausk

"Many of us saw this (study) and were really excited," says Ranella J. Hirsch, M.D., a Boston-based dermatologist in private practice and American Society of Cosmetic Dermatology and Aesthetic Surgery board member.

"I believe Botox is going to be the penicillin of the 2000s because there are so many things we don't even know that it can do that it will wind up being able to do."

"Anecdotally," she adds, "we know that facial expressions impact how one reacts to things and even to oneself," as well as how others perceive a person.

The fact that the study appeared in a peer-reviewed journal is impressive, says Kenneth Beer, M.D., assistant clinical instructor of dermatology at the University of Miami and director of Palm Beach Aesthetic Center in West Palm Beach, Fla.

"It might not be the Botox that is directly lifting the veil of depression, because Finn and Cox have demonstrated that people who get Botox look and feel better about themselves (Cox SE, Finn JC. Int Ophthalmol Clin. 2005 Summer;45(3):13-24.)," he adds.

Rather, he says, the study suggests that if depression contains a component of self-image problems, which often seems to be the case, "Improving appearance will improve the depression."

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