Glabellar Botulinum Toxin Injection Improves Depression Scores: A Systematic Review and Meta-Analysis

Abstract

epression is a leading cause of disability worldwide, interfering with daily activities, quality of life, and function, and sometimes leading to self-harm and suicide. In 2017 alone, more than 264 million people had major depressive disorder worldwide. 1 Major depressive disorder is a result of complicated interactions between psychosocial, genetic, and environmental factors that combine to produce a common constellation of symptoms that include sad or depressed mood, loss of interest, increased fatigue, feelings of guilt, and thoughts of suicide. 2 Many effective treatments for major depressive disorder exist, including psychotherapy and antidepressant medications such as selective-serotonin reuptake inhibitors and tricyclic antidepressants. Despite rapid growth in the number of available treatments for major depressive disorder over the past

A comprehensive review on the history, uses, and safety of onabotulinum toxin type A (Botox)

“…Of these, five randomized controlled trials, which utilized either the Montgomery‐Asberg Depression Rating Scale, Hamilton Depression Rating Scale, Beck Depression Inventory, or Hospital Anxiety and Depression Scale, demonstrated statistically significant improvement in depression scores 6 weeks after treatment of GLs. This collective data demonstrates the utility of BoNT‐A for its antidepressant effect when treating GLs 95 . In 2010, Dayan et al conducted a double‐blinded, randomized, placebo‐controlled study with 100 participants (randomized to treatment with ONA A vs. saline to GL, FHL, and CFLs) specifically to evaluate the psychosocial impact on quality of life (QoL) using a health outcomes survey and the Heatherton and Polivy State Self‐Esteem Scale at baseline, 2 weeks, and 3 months post treatment.…”

“…This collective data demonstrates the utility of BoNT-A for its antidepressant effect when treating GLs. 95 groups at day 30 with greater effects seen in the combination treatment group. 24 Although the validated scales for QoL impact, especially specific to aesthetic treatments, and the number of studies using similar scales are limited, the data is promising for QoL improvement with ONA facial expression treatments.…”

Botulinum Toxin Injections for Psychiatric Disorders: A Systematic Review of the Clinical Trial Landscape

“…The conducting of well-designed RCTs is pivotal for establishing the efficacy of BONT-A and spearheading its regulatory approval for treatment purposes, and most studies, as evidenced by our review, appear to employ a randomized, double-blind, controlled design. Our systematic review aimed to complement already available evidence from pooled [ 17 ] and meta-analyses [ 18 , 19 , 20 , 21 ] of BONT-A for MDD by mapping the field from a methodological standpoint and also extending the theoretical discussion for BONT-A applications to other psychiatric disorders beyond MDD; hence, we did not perform a meta-analysis due to our inherent objective to systematically map the nature of the clinical trials conducted to date and across disorders. The USA and Germany seem to be the leading countries in this research domain, as most studies are conducted and funded there.…”

“…Most studies in the field, however, have explored its therapeutic benefits for MDD specifically. MDD-focused pooled [ 17 ] and meta-analyses [ 18 , 19 , 20 , 21 ] have consistently reported a 45–55% reduction in depressive symptoms, a 50–60% response rate, and approximately one-third of patients achieving remission after BONT-A injections, concluding that BONT-A has an overall positive effect on reducing depressive symptoms in comparison to placebo injections. These conclusions are supported by the large effect sizes reported in these meta-analyses (e.g., Hedge’s g = −0.82 [95% CI, −1.38 to −0.27] [ 20 ] or Cohen’s d = 0.98 [95% CI, 0.47 to 1.49] [ 18 ]).…”

Botulinum Toxin Treatment for Depression: A New Paradigm for Psychiatry

“…Another line of evidence consists of recent meta-analyses of clinical trials to date [ 54 , 55 , 56 , 57 , 58 ]. The effect size, or Cohen’s D, of BoNT/A relative to placebo ranged from 0.82 to 1.09 across these five meta-analyses.…”