The document discusses several studies on the effects of Botox injections for depression. It summarizes that an initial study found Botox reduced depressive symptoms, but had significant methodological flaws. Subsequent studies using more rigorous methods and controls are needed to prove if Botox can effectively treat depression. Neuroimaging research also suggests Botox may decrease brain activation related to emotional processing and experience. The concept of facial feedback influencing emotions is discussed, with a reference to Charles Darwin first proposing this idea.
5. t
However, this report must be considered anecdotal as there were no appropriate
methods of control utilized. In addition, there were other methodological
weaknesses including limited follow-up, lack of randomization, the absence of
blind evaluation, and especially the small number of individuals included.
The method evaluating depression should be more rigorous. Patients’ self-report
of depressive symptoms by administration of the BDI-II introduces a significant
self-report bias. This is of more concern because of the potential for secondary
gain. While the BDI-II is an accepted method of evaluating an individual’s level of
symptoms over time, self-report in isolation is not an acceptable method of
diagnosing depression. In order to ensure that patients’ psychiatric symptoms are
accurately classified, a thorough psychiatric interview must be conducted, and a
second blind evaluator would add some credibility.
That being said, this is an intriguing report, which fits with our clinical impression.
Obviously further work is merited on this important observation.
ALASTAIR CARRUTHERS, FRCPC
Vancouver, Canada
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I must say that I was initially heartened to see the study of the treatment of
depression with Botox as many doctors will reveal a similar picture from their
patient's own experience. I examined Finzi's paper in the Journal of Dermatologic
Surgery and have concerns that this doctor used a very small number of patients,
lacked a control group, had no psychiatrist assessing the patients and even
allowed the patients to assess themselves. I noted in an accompanying
commentary, that editor Alastair Carruthers, also cited a series of flaws with the
study and concluded that its finding must be considered anecdotal. It is of more
than passing interest that this doctor has now filed a patent concerning this
treatment. If Botox does relieve depression then this is not the paper to prove it. .
Dr. Patrick Treacy
Dublin Ireland .
10. t
In the first randomized, controlled study on the effect of
botulinum toxin—known commercially as Botox—on
depression, researchers investigated whether it might aid
patients with major depressive disorder who had not
responded to antidepressant medications. Participants in the
treatment group were given a single dose (consisting of five
injections) of botulinum toxin in the area of the face between
and just above the eyebrows, whereas the control group was
given placebo injections. Depressive symptoms in the
treatment group decreased 47 percent after six weeks, an
improvement that remained through the 16-week study
period. The placebo group had a 9 percent reduction in
symptoms. The findings appeared in May in the Journal of
Psychiatric Research.
11.
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In a functional neuroimaging study, Andreas Hennenlotter and
colleagues asked participants to perform a facial expression
imitation task in an fMRI scanner before and two weeks after
receiving botox injections in the corrugator supercilii muscle
used in frowning. During imitation of angry facial expressions,
botox decreased activation of brain regions implicated in
emotional processing and emotional experience (namely, the
amygdala and the brainstem), relative to activations before
botox injection. These findings show that facial feedback
modulates neural processing of emotional content, and that
botox changes how the human brain responds to emotional
situations. Hennenlotter et al., 2008
Functional MRI and glabellar botulinum injection
13. These findings show that facial feedback modulates neural processing of emotional content,
and that botox changes how the human brain responds to emotional situations.
Hennenlotter et al., 2008
14. t
The facial feedback hypothesis states that facial movement
can influence emotional experience. For example, an
individual who is forced to smile during a social event will
actually come to find the event more of an enjoyable
experience. The free expression by outward signs of an
emotion intensifies it. On the other hand, the repression, as
far as this is possible, of all outward signs softens our
emotions... Even the simulation of an emotion tends to arouse
it in our minds.
15. t
The facial feedback hypothesis states that facial movement
can influence emotional experience. For example, an
individual who is forced to smile during a social event will
actually come to find the event more of an enjoyable
experience. The free expression by outward signs of an
emotion intensifies it. On the other hand, the repression, as
far as this is possible, of all outward signs softens our
emotions... Even the simulation of an emotion tends to arouse
it in our minds. Charles Darwin 1872
16. t
The facial feedback hypothesis states that facial movement
can influence emotional experience. For example, an
individual who is forced to smile during a social event will
actually come to find the event more of an enjoyable
experience. The free expression by outward signs of an
emotion intensifies it. On the other hand, the repression, as
far as this is possible, of all outward signs softens our
emotions... Even the simulation of an emotion tends to arouse
it in our minds.
17. t
Charles Darwin was among the first
to suggest that physiological
changes caused by an emotion had a
direct impact on, rather than being
just the consequence of that
emotion.
Charles Darwin concluded work on The Descent of Man on 15 January 1871. On
17 January 1871, he started work on The Expression of the Emotions, employing
the unused material on emotional expression. He published on 22 August 1872.
24. tThe cosmetic effect of BTX-A on wrinkles was originally
documented by a plastic surgeon from Sacramento,
California, Dr. Richard Clark, and published in the
journal Plastic and Reconstructive Surgery in 1989.
35. t
Sweating
While treating patients with hemifacial spasm at Southend
Hospital in England in 1993, Khalaf Bushara and David Park were
the first to show botulinum toxin injections inhibit sweating.[10]
This was the first demonstration of nonmuscular use of BTX-A.
Bushara further showed the efficacy of botulinum toxin in treating
hyperhidrosis (excessive sweating). BTX-A was later approved for
the treatment of excessive underarm sweating. This is technically
known as severe primary axillary hyperhidrosis - excessive
underarm sweating with an unknown cause which cannot be
managed by topical agents.