TREATING DEPRESSION WITH BOTOX? IS IT REALLY POSSIBLE?
It is difficult to accept the fact that a cosmetic (beauty) procedure can help a patient with depression.
In 2006, during his research, Dr Eric Finzi, dermatologist, injected one dose of botulinum toxinum A (onabotulinum toxin A, BTA) in the forehead of his ten patients with diagnosed depression (MDD). Ten months later, nine of his ten patients were not depressed any more. The tenth patient showed improvement of his symptoms and no remission; he was the only one with bipolar disorder.
Botulinum toxin is one of the most lethal substances known to men and is a product of anaerobic, gram-positive bacteria Clostridium botulinum.
How botulinum toxin work:
Botulinum toxin prevents secretion of acetylcholine from the nerves. It provokes muscular paralyses and could be misused as a weapon in chemical war.
However, the doctors use it in more than 50 different diseases, for example to treat migraine, cervical dystonia, strabismus, hyperactive bladder, urinal incontinency, intense perspiration, muscular cramps and now – depression!
To treat depression Botox is injected in the lower part of the forehead (glabella area). It contains two main muscles: procerus and a bigger one – corrugator. When we express fear, anger, sadness and suffering, these muscles contract and two vertical lines or an inverted ‘’U’’ letter (Omega sign) appears between the eyebrows. Botox prevents the contraction of these muscles and therefore prevents the development of the deep lines between the eyebrows.
Dose: 30-40 units of Botox are injected into five precisely determined points on glabella.
Mechanism: there are several theories:
- Facial feedback hypothesis (Charles Darwin 1872) – facial expressions influence one’s emotional status.
- A kind facial expression improves social interactions.
- BTA causes direct and indirect neuro-chemical changes in the brain, which can decrease depression. Functional MR (magnetic resonance) – studies have shown that after a glabella injection of BTA, amygdale (an area in the brain) become less responsive to the negative stimuli. BTA calms down overactive amygdale!
BTA (Botox) used to treat depression usually shows its effect two or three weeks after the injection and the effect can be felt for more than 6 months! Cosmetic (aesthetic) effects usually last about three months! It is still not clear why the anti-depressive effects last quite longer.
Is the treatment safe?
BTA in the glabella area has an extremely good safety profile.
Side effect that might appear: pain, redness, a bruise at the injection site and ptose of the upper eyelid (due to the incorrect injection!). There could be a temporary headache.
FDA in USA has not yet approved of BTA used in psychiatric indications and using it for treating depression is still ‘off-label’.