Conclusions Lacking on Botox-Depression Association

MAUI, HAWAII — A number of studies have examined the association of botulinum toxin type A treatment with reduced symptoms of depression, but the connection is still unexplained, Dr. Frederick C. Beddingfield III said at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation.

Depressive symptoms commonly occur in patients who have a negative perception about their appearance, and effective treatment often is accompanied by improved psychosocial function, but the limitations and mixed results of the studies that have been conducted leave open the question of how botulinum toxin type A (Botox) is associated with improved psychosocial function, said Dr. Beddingfield of the University of California, Los Angeles. He also is vice president and therapeutic area head of dermatology clinical research at Allergan, which manufactures Botox.

A study of botulinum toxin type A for the treatment of glabellar frown lines in 10 patients with major depressive disorder (MDD) found that 9 patients no longer had MDD after 2 months of treatment (Dermatol. Surg. 2006;32:645–50). But since the study had a small number of patients and was not randomized, blinded, or placebo controlled, the results are interesting but inconclusive, he said.

He also discussed a 4-week study of botulinum toxin type A for focal hyperhidrosis in 70 outpatients (43 female, 27 male). Reductions in depression, anxiety, and social phobia were statistically significant but clinically insignificant because patients were within normal limits at baseline. There was a statistically and clinically significant improvement in "social insecurity" scores (Br. J. Dermatol. 2005;152:342–5).

A study of 289 patients (101 men, 188 women) treated with botulinum toxin type A for cervical dystonia found that treatment was associated with less depression and anxiety, along with an improved quality of life (J. Neurol. Neurosurg. Psychiatry 2002;72:608–14).

A 4-week study of 89 patients with blepharospasm and 131 patients with cervical dystonia (CD) treated with botulinum toxin type A found improvements in clinical symptoms for both blepharospasm and CD patients, accompanied by reduced depression in CD patients (correlated with reduced neck pain) but not in blepharospasm patients, Dr. Beddingfield said.

Quality of life improved minimally for CD patients and not at all for blepharospasm patients (J. Neurol. 2002;249:842–6).

In a study of 51 outpatients (32 female, 19 male) treated for blepharospasm with botulinum toxin type A for 1–7 years, investigators found that all but 1 patient had a positive outcome from treatment (Acta Neurol. Scand. 2001;103:49–52). Twenty-nine patients felt depressed, 19 expressed fear of recurrence of blepharospasm symptoms, 27 expressed fear of increasing doses of botulinum toxin type A, 37 found widespread work improvements from therapy, and 34 said they felt more independent of other people, he said.

Of 32 patients treated for spasmodic dysphonia (SD) in another study, with follow-up for 22 patients after week 1 and 13 after 2 months, those who were depressed before treatment had significant improvements in depression and anxiety measures by 1 week following treatment. But depression and anxiety measures did not improve significantly between week 1 and month 2 after treatment (Arch. Otolaryngol. 1994;120:310–6).

There were statistically significant improvements in measures of depression, anxiety, quality of life, and somatization after 1 month in a different study of 10 patients treated with botulinum toxin type A for SD (Gen. Hosp. Psychiatry 1998;20:255–9).

A study of 26 patients (5 male, 21 female) treated for torticollis found improvements in torticollis symptoms accompanied by a statistically significant improvement in mood and reduced depression (J. Neurol. Neurosurg. Psychiatry 1992;55:229–31).

Investigators who treated 16 patients with botulinum toxin type A for idiopathic torticollis found no significant improvement in patients' or physicians' assessments of head position through five follow-up visits (Mov. Disord. 1995;10:398). There were, however, significant improvements in patients' symptoms of depression, perceived disfigurement, interference with daily activities, experience of pain, and overall impression of their torticollis, he said.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

MAUI, HAWAII — A number of studies have examined the association of botulinum toxin type A treatment with reduced symptoms of depression, but the connection is still unexplained, Dr. Frederick C. Beddingfield III said at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation.

Depressive symptoms commonly occur in patients who have a negative perception about their appearance, and effective treatment often is accompanied by improved psychosocial function, but the limitations and mixed results of the studies that have been conducted leave open the question of how botulinum toxin type A (Botox) is associated with improved psychosocial function, said Dr. Beddingfield of the University of California, Los Angeles. He also is vice president and therapeutic area head of dermatology clinical research at Allergan, which manufactures Botox.

A study of botulinum toxin type A for the treatment of glabellar frown lines in 10 patients with major depressive disorder (MDD) found that 9 patients no longer had MDD after 2 months of treatment (Dermatol. Surg. 2006;32:645–50). But since the study had a small number of patients and was not randomized, blinded, or placebo controlled, the results are interesting but inconclusive, he said.

He also discussed a 4-week study of botulinum toxin type A for focal hyperhidrosis in 70 outpatients (43 female, 27 male). Reductions in depression, anxiety, and social phobia were statistically significant but clinically insignificant because patients were within normal limits at baseline. There was a statistically and clinically significant improvement in "social insecurity" scores (Br. J. Dermatol. 2005;152:342–5).

A study of 289 patients (101 men, 188 women) treated with botulinum toxin type A for cervical dystonia found that treatment was associated with less depression and anxiety, along with an improved quality of life (J. Neurol. Neurosurg. Psychiatry 2002;72:608–14).

A 4-week study of 89 patients with blepharospasm and 131 patients with cervical dystonia (CD) treated with botulinum toxin type A found improvements in clinical symptoms for both blepharospasm and CD patients, accompanied by reduced depression in CD patients (correlated with reduced neck pain) but not in blepharospasm patients, Dr. Beddingfield said.

Quality of life improved minimally for CD patients and not at all for blepharospasm patients (J. Neurol. 2002;249:842–6).

In a study of 51 outpatients (32 female, 19 male) treated for blepharospasm with botulinum toxin type A for 1–7 years, investigators found that all but 1 patient had a positive outcome from treatment (Acta Neurol. Scand. 2001;103:49–52). Twenty-nine patients felt depressed, 19 expressed fear of recurrence of blepharospasm symptoms, 27 expressed fear of increasing doses of botulinum toxin type A, 37 found widespread work improvements from therapy, and 34 said they felt more independent of other people, he said.

Of 32 patients treated for spasmodic dysphonia (SD) in another study, with follow-up for 22 patients after week 1 and 13 after 2 months, those who were depressed before treatment had significant improvements in depression and anxiety measures by 1 week following treatment. But depression and anxiety measures did not improve significantly between week 1 and month 2 after treatment (Arch. Otolaryngol. 1994;120:310–6).

There were statistically significant improvements in measures of depression, anxiety, quality of life, and somatization after 1 month in a different study of 10 patients treated with botulinum toxin type A for SD (Gen. Hosp. Psychiatry 1998;20:255–9).

A study of 26 patients (5 male, 21 female) treated for torticollis found improvements in torticollis symptoms accompanied by a statistically significant improvement in mood and reduced depression (J. Neurol. Neurosurg. Psychiatry 1992;55:229–31).

Investigators who treated 16 patients with botulinum toxin type A for idiopathic torticollis found no significant improvement in patients' or physicians' assessments of head position through five follow-up visits (Mov. Disord. 1995;10:398). There were, however, significant improvements in patients' symptoms of depression, perceived disfigurement, interference with daily activities, experience of pain, and overall impression of their torticollis, he said.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.

MAUI, HAWAII — A number of studies have examined the association of botulinum toxin type A treatment with reduced symptoms of depression, but the connection is still unexplained, Dr. Frederick C. Beddingfield III said at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation.

Depressive symptoms commonly occur in patients who have a negative perception about their appearance, and effective treatment often is accompanied by improved psychosocial function, but the limitations and mixed results of the studies that have been conducted leave open the question of how botulinum toxin type A (Botox) is associated with improved psychosocial function, said Dr. Beddingfield of the University of California, Los Angeles. He also is vice president and therapeutic area head of dermatology clinical research at Allergan, which manufactures Botox.

A study of botulinum toxin type A for the treatment of glabellar frown lines in 10 patients with major depressive disorder (MDD) found that 9 patients no longer had MDD after 2 months of treatment (Dermatol. Surg. 2006;32:645–50). But since the study had a small number of patients and was not randomized, blinded, or placebo controlled, the results are interesting but inconclusive, he said.

He also discussed a 4-week study of botulinum toxin type A for focal hyperhidrosis in 70 outpatients (43 female, 27 male). Reductions in depression, anxiety, and social phobia were statistically significant but clinically insignificant because patients were within normal limits at baseline. There was a statistically and clinically significant improvement in "social insecurity" scores (Br. J. Dermatol. 2005;152:342–5).

A study of 289 patients (101 men, 188 women) treated with botulinum toxin type A for cervical dystonia found that treatment was associated with less depression and anxiety, along with an improved quality of life (J. Neurol. Neurosurg. Psychiatry 2002;72:608–14).

A 4-week study of 89 patients with blepharospasm and 131 patients with cervical dystonia (CD) treated with botulinum toxin type A found improvements in clinical symptoms for both blepharospasm and CD patients, accompanied by reduced depression in CD patients (correlated with reduced neck pain) but not in blepharospasm patients, Dr. Beddingfield said.

Quality of life improved minimally for CD patients and not at all for blepharospasm patients (J. Neurol. 2002;249:842–6).

In a study of 51 outpatients (32 female, 19 male) treated for blepharospasm with botulinum toxin type A for 1–7 years, investigators found that all but 1 patient had a positive outcome from treatment (Acta Neurol. Scand. 2001;103:49–52). Twenty-nine patients felt depressed, 19 expressed fear of recurrence of blepharospasm symptoms, 27 expressed fear of increasing doses of botulinum toxin type A, 37 found widespread work improvements from therapy, and 34 said they felt more independent of other people, he said.

Of 32 patients treated for spasmodic dysphonia (SD) in another study, with follow-up for 22 patients after week 1 and 13 after 2 months, those who were depressed before treatment had significant improvements in depression and anxiety measures by 1 week following treatment. But depression and anxiety measures did not improve significantly between week 1 and month 2 after treatment (Arch. Otolaryngol. 1994;120:310–6).

There were statistically significant improvements in measures of depression, anxiety, quality of life, and somatization after 1 month in a different study of 10 patients treated with botulinum toxin type A for SD (Gen. Hosp. Psychiatry 1998;20:255–9).

A study of 26 patients (5 male, 21 female) treated for torticollis found improvements in torticollis symptoms accompanied by a statistically significant improvement in mood and reduced depression (J. Neurol. Neurosurg. Psychiatry 1992;55:229–31).

Investigators who treated 16 patients with botulinum toxin type A for idiopathic torticollis found no significant improvement in patients' or physicians' assessments of head position through five follow-up visits (Mov. Disord. 1995;10:398). There were, however, significant improvements in patients' symptoms of depression, perceived disfigurement, interference with daily activities, experience of pain, and overall impression of their torticollis, he said.

SDEF and this news organization are wholly owned subsidiaries of Elsevier.