Botox Seems To Ease Depression

All sorts of science-y sounding brain drugs are used to treat serious depression: serotonin reuptake inhibitors, tricyclic antidepressants, serotonin/neuropinephrine reuptake inhibitors, atypical antipsychotics, et cetera.

But what about using a bacterial toxin that paralyzes your face muscles?

Botox, the wrinkle-smoothing drug sold by Allergan that was a major factor in that company being bought by Actavis , is one of the drug industry’s favorite things: a pipeline in a drug. It is approved for eyelid spasms, certain kinds of neck pain, urinary incontinence, and, most recently, migraine. And it is in the middle stages of development for treating depression, too.

An analysis of the data published so far presented here at the annual meeting of the American Psychiatric Association in Toronto seem to support the idea that Botox injections in the face can ease depressed mood.

The results were presented by Ajay K Parsaik, a resident at the University of Texas Medical Center. He did a search of all available scientific literature, looking at 639 articles. Six hundred-and-twenty-five of these were not relevant, six were irrelevant or incomplete, and three duplicated other studies. That left five papers for a detailed review, three of which were used in a meta-analysis that combined the data from all three studies.

One major conclusion to be drawn here is that not enough of the data have been published. But these three studies produce a fairly consistent picture. On average, the studies show a 9.8-point decrease in depression score. Eight times as many patients had their depression improve compared to control groups. And patients were 4.6 times more likely to go into remission – to have their depression symptoms vanish.

It’s thought that the treatment works because our feelings are actually connected to the muscles in our foreheads. To oversimplify: frowning may really make you sad.

We can’t be certain, based on this data, that Botox is really the new Prozac. There’s simply not enough data. And there are other concerns. For one thing, sticking a needle in someone’s face is exactly the kind of thing that could result in a substantial placebo effect. One doctor at the meeting asked if we’d also pay for breast implants and penis enlargement to make people happier.

On the other hand, if a relatively harmless  procedure can treat depression, couldn’t that be a better option for some people than many hours of talk therapy, or than taking antidepressants? It’s easy to see the appeal. Allergan's latest study of Botox in depression is expected to complete next year.