Botox for Depression? You’ve Got to be Kidding

Botox for Depression?

I have always gravitated to research approaches that are off the beaten track, such as the study of Seasonal Affective Disorder (SAD) and light therapy that I spearheaded at the National Institute of Mental Health (NIMH) over 30 years ago. At that time, seasonal affective disorder (SAD) had not yet been identified: we went on to name it and describe its typical symptoms. Light therapy, as it’s used for SAD, was unknown. My colleagues thought I had lost it. Yet now we recognize that millions of people the world over suffer from SAD and countless people have benefited from light therapy.

Dr. Eric Finzi

It was this same out-of-the-box instinct for a winner that went on alert when my colleague, Dr. Eric Finzi, a local dermatologist approached me with a novel idea for treating depression. Some years before, after leaving the NIMH, I had opened up a private clinical research organization in the hope of doing innovative and creative studies. Although that was possible to some extent (for example, I was able to study the effects of Transcendental Meditation on bipolar disorder and post-traumatic stress disorder), the reality of the work revolved mostly around testing new drugs. So, I was always on the lookout for something really different and exciting.

Dr. Finzi had read the work of Charles Darwin and the famous psychologist William James, both of whom had suggested that cues from the body, including the face, had a powerful effect on human emotions. Darwin called the frown muscles between the eyebrows “the grief muscles,” and suggested that they were not just a reflection of sorrow, but also fueled it. An extensive subsequent literature supported this “facial feedback hypothesis,” and numerous experiments showed that facial expressions affect the way we feel. Finzi has described this history in a highly readable book, The Face of Emotion. Now Finzi had an idea as to how these insights could be used to treat depression – by means of botulinum toxin (Botox), which is known to paralyze muscles. How would it be, he wondered, if we paralyzed the frown muscles between the eyebrows in a double-blind study with saline as a control? An encouraging pilot study suggested it might work. But this would now need to be tested in a controlled study. Would I be interested in conducting such a study in my research organization? Well, I loved the idea! And that was the beginning of an enjoyable collaboration.

Another reason why Finzi’s idea appealed to me so much is that over a decade before he approached me, I had written a book about the science of emotion, called The Emotional Revolution. In it I wrote:

Among the sensory nerves that influence our mood are those that pass directly through the skull and into the brain. These are known as the cranial nerves. Exposure to light stimulates one pair of these nerves, the optic nerves. Another pair, the olfactory nerves, transmits sensations of smell to the brain. The fragrance of lemons lifts the mood of depressed patients with SAD.

It was highly plausible to me that frowning might send signals to the brain via different cranial nerves – the facial and trigeminal nerves. But in this case, it seemed, the signals aggravated a person’s mood rather than relieving it. So it made all the sense in the world to me that blocking these signals might reverse depression.

So Finzi and I embarked on a controlled study of Botox for depression in collaboration with a great team of psychiatrists and administrators at my research organization. We entered 74 depressed people into a double blind, placebo controlled study and when we finally analyzed the data, the results were clear and strong. Botox beat placebo, significantly reducing depression levels, regardless of whether patients were already on antidepressants (to which they had not responded) or were untreated.

The results of the study are due to appear in the Journal of Psychiatric Research in May 2014, but the abstract is already available online:

http://www.ncbi.nlm.nih.gov/pubmed/?term=finzi+e%2C+rosenthal+ne

As a psychiatrist who has treated many people with depression, I am truly excited at this new treatment option. Although there are many available treatments for this very painful affliction, they are often only partially effective and have troublesome side-effects. I am delighted that we now have a new treatment option which can be used safely alongside all other treatments (as the Botox acts only locally in the muscles and is not absorbed). In addition, when properly administered by a trained person, Botox has few if any side-effects. So, what’s the catch? Well, first of all, as with any treatment for depression, some people don’t respond; second, it is expensive – an average treatment costs about $400; and finally, the effects of Botox wear off after about 2 to 3 months, so treatments may need to be repeated. I hope that, with replication of our findings and wider use, insurance coverage may become available. In the meanwhile, for someone suffering from the agonizing pangs of depression, the benefit of Botox may be well worth the cost.

For an additional perspective check out the following link to a New York Times piece on the subject – Don’t Worry, Get Botox.

Wishing you Light & Transcendence,

Norman