title: Facing depression with botulinum toxin: a randomized controlled trial.
abstract: 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.
authors.affiliation: Psychiatric Hospital of the University of Basel, Wilhelm-Klein-Str 27, 4012 Basel, Switzerland. axel.wollmer@unibas.ch
authors.forename: M Axel
authors.initials: MA
authors.lastname: Wollmer
authors.forename: Claas
authors.initials: C
authors.lastname: de Boer
authors.forename: Nadeem
authors.initials: N
authors.lastname: Kalak
authors.forename: Johannes
authors.initials: J
authors.lastname: Beck
authors.forename: Thomas
authors.initials: T
authors.lastname: Götz
authors.forename: Tina
authors.initials: T
authors.lastname: Schmidt
authors.forename: Muris
authors.initials: M
authors.lastname: Hodzic
authors.forename: Ursula
authors.initials: U
authors.lastname: Bayer
authors.forename: Thilo
authors.initials: T
authors.lastname: Kollmann
authors.forename: Katja
authors.initials: K
authors.lastname: Kollewe
authors.forename: Daniela
authors.initials: D
authors.lastname: Sönmez
authors.forename: Katja
authors.initials: K
authors.lastname: Duntsch
authors.forename: Martin D
authors.initials: MD
authors.lastname: Haug
authors.forename: Manfred
authors.initials: M
authors.lastname: Schedlowski
authors.forename: Martin
authors.initials: M
authors.lastname: Hatzinger
authors.forename: Dirk
authors.initials: D
authors.lastname: Dressler
authors.forename: Serge
authors.initials: S
authors.lastname: Brand
authors.forename: Edith
authors.initials: E
authors.lastname: Holsboer-Trachsler
authors.forename: Tillmann H C
authors.initials: TH
authors.lastname: Kruger
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D004311:Double-Blind Method; D005152:Facial Muscles / Q000187:drug effects* / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A