Skip to main content
SpringerLink
Log in

The Use of Botulinum Toxin for Treatment of Depression

  • Chapter
  • First Online:
Botulinum Toxin Therapy

Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 263))

Abstract

A series of clinical studies have shown that botulinum toxin can treat major depression. Subjects suffering from unipolar depression may experience a quick, strong, and sustained improvement in the symptoms of depression after a single glabellar treatment with botulinum toxin.

Preliminary data suggest that botulinum toxin therapy may also be effective in the treatment of other mental disorders characterized by an excess of negative emotions, such as borderline personality disorder.

The mood-lifting effect of botulinum toxin therapy is probably mediated by the interruption of a proprioceptive feedback loop from the facial musculature to the emotional brain.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Change history

  • 04 December 2020

    The chapter was inadvertently published without a more specific title according to SEO guidelines. A chapter title needs to be understandable when seen as a stand-alone item, e.g. on PubMed. The chapter title has now been corrected as ‘The Use of Botulinum Toxin for Treatment of Depression’.

References

  • Adelmann PK, Zajonc RB (1989) Facial efference and the experience of emotion. Annu Rev Psychol 40:249–280

    Article  CAS  PubMed  Google Scholar 

  • Al Abdulmohsen T, Kruger TH (2011) The contribution of muscular and auditory pathologies to the symptomatology of autism. Med Hypotheses 77:1038–1047

    Article  PubMed  Google Scholar 

  • Aydinlar EI, Dikmen PY, Kosak S et al (2017) OnabotulinumtoxinA effectiveness on chronic migraine, negative emotional states and sleep quality: a single-center prospective cohort study. J Headache Pain 18:23

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Baumeister JC, Papa G, Foroni F (2016) Deeper than skin deep – the effect of botulinum toxin-A on emotion processing. Toxicon 118:86–90

    Article  CAS  PubMed  Google Scholar 

  • Beer K (2010) Cost effectiveness of botulinum toxins for the treatment of depression: preliminary observations. J Drugs Dermatol 9:27–30

    PubMed  Google Scholar 

  • Boudreau GP, Grosberg BM, McAllister PJ et al (2015) Prophylactic onabotulinumtoxinA in patients with chronic migraine and comorbid depression: an open-label, multicenter, pilot study of efficacy, safety and effect on headache-related disability, depression, and anxiety. Int J Gen Med 9:79–86

    Article  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 61:961–970

    Article  CAS  PubMed  Google Scholar 

  • Caleo M, Schiavo G (2009) Central effects of tetanus and botulinum neurotoxins. Toxicon 54:593–599

    Article  CAS  PubMed  Google Scholar 

  • Carruthers A, Cohen JL, Cox SE et al (2007) Facial aesthetics: achieving the natural, relaxed look. J Cosmet Laser Ther 9(Suppl 1):6–10

    Article  PubMed  Google Scholar 

  • Cattaneo L, Pavesi G (2014) The facial motor system. Neurosci Biobehav Rev 38:135–159

    Article  PubMed  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

    Article  PubMed  Google Scholar 

  • Cobo JL, Sole-Magdalena A, Menendez I et al (2017) Connections between the facial and trigeminal nerves: anatomical basis for facial muscle proprioception. JPRAS Open 12:9–18

    Article  Google Scholar 

  • Cohen IV, Makunts T, Atayee R et al (2017) Population scale data reveals the antidepressant effects of ketamine and other therapeutics approved for non-psychiatric indications. Sci Rep 7:1450

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Coles NA, Larsen JT, Lench HC (2019) A meta-analysis of the facial feedback literature: effects of facial feedback on emotional experience are small and variable. Psychol Bull 145:610–651

    Article  PubMed  Google Scholar 

  • Davis JI, Senghas A, Brandt F et al (2010) The effects of BOTOX injections on emotional experience. Emotion 10:433–440

    Article  PubMed  PubMed Central  Google Scholar 

  • Demiryurek BE, Ertem DH, Tekin A et al (2016) Effects of onabotulinumtoxinA treatment on efficacy, depression, anxiety, and disability in Turkish patients with chronic migraine. Neurol Sci 37:1779–1784

    Article  PubMed  Google Scholar 

  • Dodick DW, Turkel CC, RE DG, PREEMPT Chronic Migraine Study Group et al (2010) OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache 50:921–936

    Article  PubMed  Google Scholar 

  • Ekman P, Friesen WV (1978) Facial action coding system: a technique for the measurement of facial movement. Consulting Psychologists Press, Palo Alto

    Google Scholar 

  • Ekman P, Levenson PW, Friesen WV (1983) Autonomic nervous system activity distinguishes among emotions. Science 212:1208–1210

    Article  Google Scholar 

  • Finzi E, Rosenthal NE (2014) Treatment of depression with onabotulinumtoxinA: a randomized, double-blind, placebo controlled trial. J Psychiatr Res 52:1–6

    Article  PubMed  Google Scholar 

  • Finzi E, Rosenthal NE (2016) Emotional proprioception: treatment of depression with afferent facial feedback. J Psychiatr Res 80:93–96

    Article  PubMed  Google Scholar 

  • Finzi E, Rosenthal NE (2019) Botulinum toxin therapy of social anxiety disorder: a case series. J Clin Psychopharmacol 39:410–412

    Article  PubMed  Google Scholar 

  • Finzi E, Wasserman E (2006) Treatment of depression with botulinum toxin A: a case series. Dermatol Surg 32:645–649

    CAS  PubMed  Google Scholar 

  • Finzi E, Kels L, Axelowitz J et al (2018) Botulinum toxin therapy of bipolar depression: a case series. J Psychiatr Res 104:55–57

    Article  CAS  PubMed  Google Scholar 

  • Golden SA, Christoffel DJ, Heshmati M et al (2013) Epigenetic regulation of RAC1 induces synaptic remodeling in stress disorders and depression. Nat Med 19:337–344

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • 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 142:348–351

    Article  CAS  PubMed  Google Scholar 

  • Guerzoni S, Pellesi L, Baraldi C et al (2015) Increased efficacy of regularly repeated cycles with OnabotulinumtoxinA in MOH patients beyond the first year of treatment. J Headache Pain 17:48

    Article  PubMed  CAS  Google Scholar 

  • Guerzoni S, Pellesi L, Baraldi C et al (2017) Long-term treatment benefits and prolonged efficacy of OnabotulinumtoxinA in patients affected by chronic migraine and medication overuse headache over 3 years of therapy. Front Neurol 8:586

    Article  PubMed  PubMed Central  Google Scholar 

  • Havas DA, Glenberg AM, Gutowski KA et al (2010) Cosmetic use of botulinum toxin-a affects processing of emotional language. Psychol Sci 21:895–900

    Article  PubMed  Google Scholar 

  • Heckmann M, Teichmann B, Schroder U et al (2003) Pharmacologic denervation of frown muscles enhances baseline expression of happiness and decreases baseline expression of anger, sadness, and fear. J Am Acad Dermatol 49:213–216

    Article  PubMed  Google Scholar 

  • 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 19:537–542

    Article  PubMed  Google Scholar 

  • Hexsel D, Brum C, Siega C et al (2013) Evaluation of self-esteem and depression symptoms in depressed and nondepressed subjects treated with onabotulinumtoxinA for glabellar lines. Dermatol Surg 39:1088–1096

    Article  CAS  PubMed  Google Scholar 

  • Ibragić S, Matak I, Dračić A et al (2016) Effects of botulinum toxin type A facial injection on monoamines and their metabolites in sensory, limbic and motor brain regions in rats. Neurosci Lett 617:213–217

    Article  PubMed  CAS  Google Scholar 

  • Kim MJ, Neta M, Davis FC et al (2014) Botulinum toxin-induced facial muscle paralysis affects amygdala responses to the perception of emotional expressions: preliminary findings from an A-B-A design. Biol Mood Anxiety Disord 4:11

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Kollewe K, Escher CM, Wulff DU et al (2016) Long-term treatment of chronic migraine with OnabotulinumtoxinA: efficacy, quality of life and tolerability in a real-life setting. J Neural Transm 123:533–540

    Article  CAS  PubMed  Google Scholar 

  • Kruger TH, Wollmer MA (2015) Depression--an emerging indication for botulinum toxin treatment. Toxicon 107:154–157

    Article  CAS  PubMed  Google Scholar 

  • Kruger TH, Magid M, Wollmer MA (2016) Can botulinum toxin help patients with borderline personality disorder? Am J Psychiatry 173:940–941

    Article  PubMed  Google Scholar 

  • Lewis MB, Bowler PJ (2009) Botulinum toxin cosmetic therapy correlates with a more positive mood. J Cosmet Dermatol 8:24–26

    Article  PubMed  Google Scholar 

  • Li Y, Liu J, Liu X (2019) Antidepressant-like action of single facial injection of botulinum neurotoxin A is associated with augmented 5-HT levels and BDNF/ERK/CREB pathways in mouse brain. Neurosci Bull 35(4):661–672

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Maasumi K, Thompson NR, Kriegler JS (2015) Effect of OnabotulinumtoxinA injection on depression in chronic migraine. Headache 55:1218–1224

    Article  PubMed  Google Scholar 

  • 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 75:837–844

    Article  CAS  PubMed  Google Scholar 

  • Magid M, Finzi E, Kruger TH et al (2015) Treating depression with botulinum toxin: a pooled analysis of randomized controlled trials. Pharmacopsychiatry 48:205–210

    Article  CAS  PubMed  Google Scholar 

  • Marchand-Pauvert V, Aymard C, Giboin LS et al (2013) Beyond muscular effects: depression of spinal recurrent inhibition after botulinum neurotoxin A. J Physiol 591:1017–1029

    Article  CAS  PubMed  Google Scholar 

  • Matsuo K, Ban R, Hama Y et al (2015) Eyelid opening with trigeminal proprioceptive activation regulates a brainstem arousal mechanism. PLoS One 10:e0134659

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Molina B, Grangier Y, Mole B (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 29:1382–1388

    Article  CAS  PubMed  Google Scholar 

  • Parsaik AK, Mascarenhas SS, Hashmi A et al (2016) Role of botulinum toxin in depression. J Psychiatr Pract 22:99–110

    Article  PubMed  Google Scholar 

  • Schwartz GE, Fair PL, Salt P et al (1976) Facial muscle patterning to affective imagery in depressed and nondepressed subjects. Science 192:489–491

    Article  CAS  PubMed  Google Scholar 

  • Sommer B, Zschocke I, Bergfeld D et al (2003) Satisfaction of patients after treatment with botulinum toxin for dynamic facial lines. Dermatol Surg 29:456–460

    PubMed  Google Scholar 

  • Wollmer MA, de Boer C, Kalak N et al (2012) Facing depression with botulinum toxin: a randomized controlled trial. J Psychiatr Res 46:574–581

    Article  PubMed  Google Scholar 

  • Wollmer MA, Kalak N, Jung S et al (2014) Agitation predicts response of depression to botulinum toxin treatment in a randomized controlled trial. Front Psych 5:36

    Google Scholar 

  • Wollmer MA, Neumann I, Magid M et al (2018) Shrink that frown! Botulinum toxin therapy is lifting the face of psychiatry. G Ital Dermatol Venereol 153:540–548

    PubMed  Google Scholar 

  • 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 46:982–984

    PubMed  PubMed Central  Google Scholar 

  • Zhang H, Zhang H, Wei Y et al (2017) Treatment of chronic daily headache with comorbid anxiety and depression using botulinum toxin A: a prospective pilot study. Int J Neurosci 127:285–290

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Asklepios Clinic North–Ochsenzoll, Asklepios Campus Hamburg, Medical Faculty, Semmelweis University, Hamburg, Germany

    M. Axel Wollmer

  2. Dell Medical School, University of Texas at Austin, Austin, TX, USA

    Michelle Magid

  3. Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Hannover, Germany

    Tillmann H. C. Kruger

  4. Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine, Washington, DC, USA

    Eric Finzi

Authors
  1. M. Axel Wollmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michelle Magid
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tillmann H. C. Kruger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eric Finzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Axel Wollmer .

Editor information

Editors and Affiliations

  1. Akrivista and Whitecap Biosciences, Irvine, CA, USA

    Scott M. Whitcup

  2. Bethesda, MD, USA

    Mark Hallett

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Wollmer, M.A., Magid, M., Kruger, T.H.C., Finzi, E. (2019). The Use of Botulinum Toxin for Treatment of Depression. In: Whitcup, S.M., Hallett, M. (eds) Botulinum Toxin Therapy. Handbook of Experimental Pharmacology, vol 263. Springer, Cham. https://doi.org/10.1007/164_2019_272

Download citation

Publish with us

Policies and ethics

Search

Navigation