title: Treating depression with botulinum toxin: a pooled analysis of randomized controlled trials.
abstract: BACKGROUND
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry, University of Texas at Austin, Dell Medical School, Austin, TX, USA (MM).
authors.forename: M
authors.initials: M
authors.lastname: Magid
authors.affiliation: Department of Psychiatry, George Washington School of Medicine, USA.
authors.forename: E
authors.initials: E
authors.lastname: Finzi
authors.affiliation: Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Germany (THCK, SJ).
authors.forename: T H C
authors.initials: TH
authors.lastname: Kruger
authors.affiliation: Department of Analytics, Seton Family of Hospitals, Austin, TX, USA (HR).
authors.forename: H T
authors.initials: HT
authors.lastname: Robertson
authors.affiliation: Department of Dermatology, University of Texas at Austin, Dell Medical School, Austin, TX, USA (BHK, JSR).
authors.forename: B H
authors.initials: BH
authors.lastname: Keeling
authors.affiliation: Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Germany (THCK, SJ).
authors.forename: S
authors.initials: S
authors.lastname: Jung
authors.affiliation: Department of Dermatology, University of Texas at Austin, Dell Medical School, Austin, TX, USA (BHK, JSR).
authors.forename: J S
authors.initials: JS
authors.lastname: Reichenberg
authors.affiliation: Capital Clinical Research Associates, Rockville, MD, USA (NER).
authors.forename: N E
authors.initials: NE
authors.lastname: Rosenthal
authors.affiliation: Asklepios Clinic North - Ochsenzoll, Asklepios Campus Hamburg, Medical Faculty, Semmelweis University, Germany (SJ, MAW).
authors.forename: M A
authors.initials: MA
authors.lastname: Wollmer
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A