Positive effects on mood have been observed in subjects who underwent treatment of glabellar frown lines with botulinum toxin and, in an open case series, depression remitted or improved after such treatment. Using a randomized double-blind placebo-controlled trial design we assessed botulinum toxin injection to the glabellar region as an adjunctive treatment of major depression. Thirty patients were randomly assigned to a verum (onabotulinumtoxinA, n = 15) or placebo (saline, n = 15) group. The primary end point was change in the 17-item version of the Hamilton Depression Rating Scale six weeks after treatment compared to baseline. The verum and the placebo groups did not differ significantly in any of the collected baseline characteristics. Throughout the sixteen-week follow-up period there was a significant improvement in depressive symptoms in the verum group compared to the placebo group as measured by the Hamilton Depression Rating Scale (F((6,168)) = 5.76, p < 0.001, η(2) = 0.17). Six weeks after a single treatment scores of onabotulinumtoxinA recipients were reduced on average by 47.1% and by 9.2% in placebo-treated participants (F((1,28)) = 12.30, p = 0.002, η(2) = 0.31, d = 1.28). The effect size was even larger at the end of the study (d = 1.80). Treatment-dependent clinical improvement was also reflected in the Beck Depression Inventory, and in the Clinical Global Impressions Scale. This study shows that a single treatment of the glabellar region with botulinum toxin may shortly accomplish a strong and sustained alleviation of depression in patients, who did not improve sufficiently on previous medication. It supports the concept, that the facial musculature not only expresses, but also regulates mood states.

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Female and male alcohol dependent patients present an inhomogeneous group regarding to the drinking outcome. Stress, as well as stress-coping-styles are relevant predictive factors for the progress of alcohol dependence. Methods: Social data, data of drinking behaviour, stress-styles and cortisol concentrations in plasma and cerebrospinal fluid (CSF) were measured in 130 patients with alcohol dependence (35F and 95M) before and after inpatient treatment. The age of onset alcohol dependence, the amount of alcohol consumption since last 3 months, the responsibility for education from children, living situation, and the practice of positive ore negative stress coping styles were investigated. Results: Female alcohol dependent patients show a significant higher age of onset for alcohol dependence (p=0.02) and have a significant lower consumption of alcohol in relation to male alcohol dependent patients (p=0.004). Moreover, female alcohol dependent patients are significant more frequent involved in education of children (p=0.04), and are living significant less alone (p=0.023). The cortisol levels in plasma and CSF between female and male alcohol dependent patients does not differ. However, female alcoholics show a significant higher score of negative stress-coping styles than male alcoholics (p= 0.023). Conclusion: There are significant psychosocial differences between female and male alcohol dependent patients. These gender specific differences relating to social stressors and handling with stress may be clinical relevant for treatment and outcome in alcohol-dependent patients.

IntroductionFrowning expresses negative emotions like anger, fear, and sadness. According to the facial feedback hypothesis, suppression of frowning will also diminish the corresponding negative emotions. Hence, mood improvement has been observed in patients who underwent treatment of glabellar frown lines with botulinum neurotoxin. This observation suggests the possibility that the intervention may be employed for the management of psychiatric disorders associated with negative emotions. Preliminary data from an open case series indicate that the intervention might improve the symptoms of depression.Aims & objectivesTo test whether an onabotulinumtoxinA injection into the glabellar region is benefical as an adjunctive treatment of major depression within a clinical trial.MethodsWe used a randomized, double-blinded, placebo-controlled study design (n = 30; ClinicalTrials.gov, number, NCT00934687).ResultsWe show that a single onabotulinumtoxinA treatment shortly leads to a strong and sustained improvement in partly chronic major depression that did not respond sufficiently to previous treatment. As for the primary end-point, Hamilton Depression Rating Scale (HAM-D17) six weeks after treatment compared to baseline, scores of onabotulinumtoxinA recipients showed 37.9% (8.34 points) more improvement than those of placebo-treated participants (F = 12.30, p = 0.002, η2 = 0.31, d = 1.28).ConclusionOur findings support the concept that the facial musculature not only expresses, but also regulates, mood states. As it stands, treatment of glabellar frown lines with botulinum neurotoxin can be considered for depressed patients with the objective of inducing mood-lifting effects.

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