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Chapter 26 - Treatment of Depression with Botulinum Toxin

Published online by Cambridge University Press:  02 November 2023

By
M. Axel Wollmer ,
Michelle Magid ,
Tillmann H. C. Kruger  and
Eric Finzi
Edited by
Daniel Truong ,
Dirk Dressler ,
Mark Hallett ,
Christopher Zachary  and
Mayank Pathak
Daniel Truong
Affiliation:
University of California, Riverside
Dirk Dressler
Affiliation:
Hannover Medical School
Mark Hallett
Affiliation:
National Institutes of Health (NIH)
Christopher Zachary
Affiliation:
University of California, Irvine
Mayank Pathak
Affiliation:
Truong Neuroscience Institute
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Summary

The glabellar region of the face harbors the so called grief muscles (corrugator and procerus muscles). Combined contraction of the corrugator muscle and the medial part of the frontalis muscle account for facial features of emotional distress like the ’omega melancholicum’ or Veraguth’s folds and can be observed frequently in patients suffering from mental disorders including depression.

According to the facial feedback hypothesis, the facial expression of emotions generates proprioceptive feedback signals that can maintain and reinforce the expressed emotions. Relaxation of glabellar muscles by means of botulinum toxin (BoNT) injections may not only give the face a less negative and more positive expression, but may also interrupt the described feedback loop and thereby lead to a less negative and more positive emotional state.

This chapter summarizes the studies showing the effect of BoNT treatment on depression, illustrates the pertinent facial expressions and the underlying muscles that produce grief expression and shows the recommended injection sites along with dose recommendations.

Keywords

Depressiongrief musclesomega melancholicumVeraguth’s foldsfacial feedback hypothesis
Type
Chapter
Information
Manual of Botulinum Toxin Therapy , pp. 218 - 222
Publisher: Cambridge University Press
Print publication year: 2023

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References

Adelmann, PK, Zajonc, RB (1989). Facial efference and the experience of emotion. Ann Rev Psychol, 40, 249–80.Google Scholar
Brin, MF, Boodhoo, TI, Pogoda, JM et al. (2009). Safety and tolerability of onabotulinumtoxinA in the treatment of facial lines: a meta-analysis of individual patient data from global clinical registration studies in 1678 participants. J Am Acad Dermatol, 61, 961–70.Google Scholar
Brin, MF, Durgam, S, Lum, A et al. (2020). OnabotulinumtoxinA for the treatment of major depressive disorder: a phase 2 randomized, double-blind, placebo-controlled trial in adult females. Int Clin Psychopharmacol, 35, 19–28.CrossRefGoogle ScholarPubMed
Caleo, M, Schiavo, G (2009). Central effects of tetanus and botulinum neurotoxins. Toxicon, 54, 593–9.Google Scholar
Chugh, S, Chhabria, A, Jung, S et al. (2018). Botulinum toxin as a treatment for depression in a real-world setting. J Psychiatr Pract, 24, 15–20.CrossRefGoogle ScholarPubMed
Ekman, P, Friesen, WV (1978). Facial Action Coding System: A Technique for the Measurement of Facial Movement. Palo Alto: Consulting Psychologists Press.Google Scholar
Finzi, E, Kels, L, Axelowitz, J et al. (2018). Botulinum toxin therapy of bipolar depression: a case series. J Psychiatr Res, 104, 55–7.CrossRefGoogle ScholarPubMed
Finzi, E, Rosenthal, NE (2014). Treatment of depression with onabotulinumtoxinA: a randomized, double-blind, placebo controlled trial. J Psychiatr Res, 52, 1–6.CrossRefGoogle ScholarPubMed
Finzi, E, Rosenthal, NE (2016). Emotional proprioception: treatment of depression with afferent facial feedback. J Psychiatr Res, 80, 93–6.CrossRefGoogle ScholarPubMed
Finzi, E, Wasserman, E (2006). Treatment of depression with botulinum toxin A: a case series. Dermatol Surg, 32, 645–9.Google ScholarPubMed
Greden, JF, Genero, N, Price, HL (1985). Agitation-increased electromyogram activity in the corrugator muscle region: a possible explanation of the “Omega sign”? Am J Psychiatry, 142, 348–51.Google ScholarPubMed
Hennenlotter, A, Dresel, C, Castrop, F et al. (2009). The link between facial feedback and neural activity within central circuitries of emotion-new insights from botulinum toxin-induced denervation of frown muscles. Cereb Cortex, 19, 537–42.CrossRefGoogle ScholarPubMed
Lewis, MB (2018). The interactions between botulinum-toxin-based facial treatments and embodied emotions. Sci Rep, 8,14720.Google Scholar
Lewis, MB, Bowler, PJ (2009). Botulinum toxin cosmetic therapy correlates with a more positive mood. J Cosmet Dermatol, 8, 24–6.Google Scholar
Li, Y, Liu, T, Luo, W (2021). Botulinum neurotoxin therapy for depression: therapeutic mechanisms and future perspective. Front Psychiatry, 12, 584416.Google Scholar
Magid, M, Finzi, E, Kruger, TH et al. (2015). Treating depression with botulinum toxin: a pooled analysis of randomized controlled trials. Pharmacopsychiatry, 48, 205–10.Google ScholarPubMed
Magid, M, Reichenberg, JS, Poth, PE et al. (2014). Treatment of major depressive disorder using botulinum toxin A: a 24-week randomized, double-blind, placebo-controlled study. J Clin Psychiatry, 75, 837–44.CrossRefGoogle ScholarPubMed
Molina, B, Grangier, Y, Mole, B et al. (2015). Patient satisfaction after the treatment of glabellar lines with botulinum toxin type A (Speywood Unit): a multi-centre European observational study. J Eur Acad Dermatol Venereol, 29, 1382–8.Google Scholar
Parsaik, AK, Mascarenhas, SS, Hashmi, A et al. (2016). Role of botulinum toxin in depression. J Psychiatr Pract, 22, 99–110.CrossRefGoogle ScholarPubMed
Schulze, J, Neumann, I, Magid, M et al. (2021). Botulinum toxin for the management of depression: an updated review of the evidence and meta-analysis. J Psychiatr Res, 135, 332–40.CrossRefGoogle ScholarPubMed
Schwartz, GE, Fair, PL, Salt, P et al. (1976). Facial muscle patterning to affective imagery in depressed and nondepressed subjects. Science, 192, 489–91.CrossRefGoogle ScholarPubMed
Sommer, B, Zschocke, I, Bergfeld, D et al. (2003). Satisfaction of patients after treatment with botulinum toxin for dynamic facial lines. Dermatol Surg, 29, 456–60.Google ScholarPubMed
Weise, D, Weise, CM, Naumann, M (2019). Central effects of botulinum neurotoxin-evidence from human studies. Toxins, 11, 21.Google Scholar
Wollmer, MA, de Boer, C, Kalak, N et al. (2012). Facing depression with botulinum toxin: a randomized controlled trial. J Psychiatr Res, 46, 574–81.CrossRefGoogle ScholarPubMed
Wollmer, MA, Kalak, N, Jung, S et al. (2014). Agitation predicts response of depression to botulinum toxin treatment in a randomized controlled trial. Front Psychiatr, 5, 36.CrossRefGoogle ScholarPubMed
Zamanian, A, Ghanbari Jolfaei, A, Mehran, G et al. (2017). Efficacy of botox versus placebo for treatment of patients with major depression. Iran J Public Health, 46, 982–4.Google ScholarPubMed

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