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It might be safe to say that few of us have ever thought of the wrinkle treatment known as Botox as a possible treatment for depression. There are researchers, though, who say it works.
Researchers at the Hannover Medical School in Hamburg, Germany have been experimenting with the injection of botulinum toxin (Botox or BTX) into the facial muscles that express emotion. Their initial findings have shown substantial improvement in depression symptoms.
The thinking of this group of researchers is that emotions are expressed by facial muscles. These expressions, in turn, send signals to the brain to reinforce these emotions. By interrupting the physical manifestations of negative emotions, through injection of Botox, the emotions themselves are alleviated.
Botulinum toxin is a lethal neurotoxin that acts as a paralytic agent in the muscles. It has been used commercially as a beauty treatment since about 1990. When injected into certain muscle groups on the face, the muscles relax and wrinkles are smoothed, effects that last between four and six months. It has other medical uses, including treatment of crossed eyes (strabismus) and uncontrollable blinking (blepharospasm), treatment of lower esophageal sphincter spasms and inhibition of sweating in those who suffer from this disorder (hyperhidrosis).
Ironically, the first indications that depressed feelings were remitted or improved by Botox injections came from those who were using the treatment to reduce facial wrinkles. This therapeutic benefit seemed to continue long after the cosmetic benefit had disappeared. To prove or disprove these observations, researchers conducted a randomized, double blind study with 30 participants, all of whom suffered from serious, chronic depression.
The reduction in depressive symptoms was measured using the 17-item Hamilton Depression Rating Scale (HAMD17) during the 16 week study. The results after six weeks and a single injection of either Botox or the placebo was a 47.1% reduction in HAMD17 scores for the Botox recipients vs. 9.2% in the placebo group. By the end of the study, the positive effect was even larger.
These findings have been reproduced in two other studies, reported at the American Academy of Dermatology at their annual meeting in March 2014 and in the Journal of Psychiatric Research in May.
All of the studies to date have been relatively small, and questions still remain as to whether the response is a result of changes to the internal circuitry to the brain resulting from changes in the patient's emotional expression, or to the possible effect of emotional reactions from those who interact with the patient, who is now exhibiting a more relaxed and happy demeanor.
There are cautions to the use of Botox as a cosmetic treatment. The botulinum toxin contained in Botox can spread to other body areas beyond where it was injected. This has caused serious, life-threatening side effects in some people receiving botulism toxin injections, even for cosmetic purposes. These reactions are rare, however.
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