Botox injections could reduce depression and benefit patient no matter where it is injected, finds study
Botox, a medication derived from a bacterial toxin, is commonly injected to ease wrinkles, migraines, muscle spasms, excessive sweating and incontinence. Researchers now say that it can also lessen depression. Authors from Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California (UC) San Diego mined the US Food and Drug Administration's (FDA) Adverse Effect Reporting System (FAERS) database to see what nearly 40,000 people reported happened to them after treatment with Botox for a variety of reasons.
They discovered that people who received Botox injections — at six different sites, not just in the forehead — reported depression significantly less often than patients undergoing different treatments for the same conditions. Depression was reported 40% to 88% less often by Botox-treated patients for six of the eight conditions and injection sites. Funded by the National Institutes of Health (NIH), the study has been published in Scientific Reports.
“Analysis of a large number of reports show a consistent and statistically significant beneficial effect of Botulinum toxin injections beyond injection in the forehead frown lines for cosmetic purposes. Five other injection sites related to different therapeutic indications also show a statistically significant effect of the Botox injections. This observation modifies and expands the possibilities for repurposing Botox injections to the treatment of depression specifically,” senior author Dr Ruben Abagyan, professor at Skaggs School of Pharmacy and Pharmaceutical Sciences, tells MEA WorldWide (MEAWW).
"This finding is exciting because it supports a new treatment to affect mood and fight depression, one of the common and dangerous mental illnesses, and it's based on a very large body of statistical data, rather than limited-scale observations," says Tigran Makunts, PharmD, who was a pharmacy student at the time when the study was conducted and is now a research fellow at the FDA.
The FAERS database contains more than 13 million voluntary reports of adverse effects people experienced while taking a medication. The research team found they can also use the database to look at the absence of a health complaint when a person takes a medication if compared to a control group. In this case, they searched for the absence of depression.
They focused on close to 40,000 FAERS reports of people experiencing adverse events after Botox treatment. The reports cover Botox treatment for eight different reasons and injection sites, including forehead, neck, limbs, and bladder. The team applied a mathematical algorithm to look for statistically significant differences between Botox users and patients who received different treatments for the same conditions.
“The baseline of depression-related signs and symptoms gets reduced by the Botox treatments in different sites. In six out of eight sights the result is statistically significant at a 95% confidence range. And for the two remaining sites, it is not significant because of the paucity of the data and a wider 95% confidence range, however, the antidepressant effect is still present,” Dr Abagyan says.
Authors emphasize that the data used in this study was not collected to explore the association between Botox use and depression exclusively. Besides, the FAERS data represents only the subset of Botox users who experienced negative side effects. While the team excluded reports in which a person was also taking antidepressants, the use of other prescription and over-the-counter medications could have been underreported in some cases, they add.
The World Health Organization (WHO) estimates that more than 264 million worldwide experience depression. The forehead injection of Botox is currently being tested in clinical trials for its ability to treat depression. "Depression is frequently treated with psychotherapy, selective serotonin reuptake inhibitors, dopamine-norepinephrine reuptake inhibitors, and/or serotonin-norepinephrine reuptake inhibitors. Yet these approaches are ineffective for nearly one-third of patients. That’s why clinicians and researchers are exploring other therapeutic options, including electroconvulsive therapy, transcranial magnetic stimulation, ketamine infusions, and, more recently, Botox forehead injections,” say experts.
According to researchers, the clinical trial underway is directly testing Botox treatment for people with depression, a "gold standard approach" for gathering insight on the relationship between a medication and a health condition. Since that trial is only testing forehead injection of Botox, Dr Abagyan says that additional clinical trials may be necessary to work out the best site and dose to administer the medication specifically for the treatment of depression. Likewise, more research is needed to determine the mechanism by which Botox acts as an antidepressant, he suggets.
Researchers hypothesize a few possibilities worth investigating such as Botox could be transported to the regions of the central nervous systems involved in mood and emotions. Or, since Botox is commonly used to treat chronic conditions that may contribute to depression, its success in relieving the underlying problem may indirectly also relieve depression, the team theorizes.