Treatment of Mental Health Disorders with Botulinum Toxin

A special issue of Toxins (ISSN 2072-6651). This special issue belongs to the section "Bacterial Toxins".

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 5407

Special Issue Editors

The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
Interests: botulinum toxin
Asklepios Clinic North-Ochsenzoll, Asklepios Campus Hamburg, Medical Faculty, Semmelweis University, 22419 Hamburg, Germany
Interests: injection; botulina toxin A; incobotulinumtoxin

Special Issue Information

Dear Colleagues,

Since the first trial in 2006 showing that major depression could be treated with botulinum toxin, a new field has emerged: using neuromodulators to treat mental health disorders. There are now over 30 clinical reports of using botulinum toxin in the frown area to treat major depression, bipolar depression, borderline personality disorder and social anxiety. Depressive symptoms in a number of conditions, such as Parkinson’s disease, migraines, and blepharospasm, have improved after treatment with botulinum toxin. Rodent models confirm the antidepressant and anti-anxiety properties of the compound. Imaging of the brain reveals a key structure in emotional regulation, the amygdala, to be downregulated after botulinum toxin treatment of the frown area. In addition, subjects using botulinum toxin for a variety of conditions report lower incidences of depression and anxiety. In this Special Issue, we are collecting research on the burgeoning use of botulinum toxin to treat mental health disorders.

Dr. Eric Finzi
Dr. Marc Axel Wollmer
Guest Editors

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Keywords

  • major depression
  • bipolar depression
  • anxiety
  • social anxiety
  • emotion
  • amygdala
  • mental health

Published Papers (2 papers)

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12 pages, 916 KiB  
Article
Botulinum Toxin Therapy for Psychiatric Disorders in Clinical Practice: A Retrospective Case Study
by Franziska Lehnert, Insa Neumann, Tillmann H. C. Krüger and Marc A. Wollmer
Toxins 2023, 15(6), 385; https://doi.org/10.3390/toxins15060385 - 07 Jun 2023
Cited by 1 | Viewed by 1448
Abstract
Inhibiting the facial expression of negative emotions via botulinum toxin A (BTX) has been shown to mitigate symptoms of clinical depression in randomized controlled trials. This retrospective case study sought to reproduce the beneficial effects of BTX in a naturalistic setting for major [...] Read more.
Inhibiting the facial expression of negative emotions via botulinum toxin A (BTX) has been shown to mitigate symptoms of clinical depression in randomized controlled trials. This retrospective case study sought to reproduce the beneficial effects of BTX in a naturalistic setting for major depressive disorder and collect casuistic data on its effect on other mental disorders. Moreover, we describe symptom development across multiple treatment cycles with BTX, and assess the implementation of additional injection targets in the lower face region. Participants were N = 51 adult psychiatric outpatients mainly seeking treatment for depression. Over 50% suffered from comorbid psychiatric conditions, predominantly generalized anxiety disorder (GAD) or borderline personality disorder (BPD). A pre–post case series design was adapted. All participants received BTX-injections in the glabellar region on at least one occasion. Some received additional injections in the mouth region and over multiple treatment cycles. Treatment response was followed up by self-rated scales at varying time intervals post treatment. The results showed that BTX may yield favorable outcomes across multiple and comorbid mental disorders, especially, however, for patients suffering from depression. It potentially prevents the recurrence of clinical symptoms if applied regularly. Adding additional regions of the face does not seem to be superior over applying it to the glabellar region alone. The results add to the growing evidence that BTX therapy is effective in alleviating symptoms of depression. Positive effects can be sustained and reinstated, when applied over multiple treatment cycles. Observed symptom reduction in other psychiatric disorders was less pronounced. Further research is needed to understand the mechanisms by which BTX therapy reduces psychiatric symptoms. Full article
(This article belongs to the Special Issue Treatment of Mental Health Disorders with Botulinum Toxin)
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Review

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12 pages, 563 KiB  
Review
Botulinum Toxin Treatment for Depression: A New Paradigm for Psychiatry
by Eric Finzi
Toxins 2023, 15(5), 336; https://doi.org/10.3390/toxins15050336 - 14 May 2023
Cited by 1 | Viewed by 3525
Abstract
Multiple randomized double-blind placebo-controlled trials have shown that botulinum toxin A (BoNT/A), when injected into the frown musculature, is an antidepressant. This review outlines the conceptual narrative behind this treatment modality, starting with theory developed by Charles Darwin. We develop the concept of [...] Read more.
Multiple randomized double-blind placebo-controlled trials have shown that botulinum toxin A (BoNT/A), when injected into the frown musculature, is an antidepressant. This review outlines the conceptual narrative behind this treatment modality, starting with theory developed by Charles Darwin. We develop the concept of emotional proprioception and discuss how the muscles of facial expression play an important role in relaying valenced information to the brain’s emotional neuroanatomical circuit. We review the role of facial frown musculature as the brain’s barometer and transmitter of negatively valanced emotional information. The direct connections between the corrugator muscles and the amygdala are reviewed, and these provide a neuroanatomical circuit that is a logical target for treatment with BoNT/A. The centrality of amygdala dysfunction in the pathogenesis of many psychiatric disorders, and the evidence that BoNT/A modulates amygdala activity, provides the mechanistic link between BoNT/A and its antidepressant activity. Animal models of BoNT/A’s antidepressant effects confirm the evolutionary conservation of this emotional circuit. The clinical and theoretical implications of this evidence, as it relates to the potential treatment of a broad range of psychiatric disorders by BoNT/A, is discussed. The ease of administration, long duration, and favorable side effect profile of this therapy is reviewed in the context of existing antidepressant treatments. Full article
(This article belongs to the Special Issue Treatment of Mental Health Disorders with Botulinum Toxin)
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