Local doctors using Botox to fight depression

AUSTIN (KXAN) — “We didn’t want people who wanted free BOTOX, they had to be clinically depressed,” said Austin psychologist Michelle Magid who has treated thousands of people with major depression, as she explained a recent study that shows Botox can be used to fight depression.

“What I do is I see significantly ill patients, treatment resistant patients, the most severe depression,” says Magid, a specialist in treatment-resistant depression. before-and-after-botox

According to a recent survey, 20 million Americans suffer from depression including ten percent of Texans. Of those, Magid says, a third of the patients are treatment resistant, meaning they don’t respond to medications or psychotherapy.

“There has to be other options out there,” Magid says.

Magid turned to someone she knows all too well in her search for answers.

“So I’m a psychologist and he’s a dermatologist. We tend to talk about a lot of medicine at night,” says Magid pointing to her husband Dr. Jason Reichenberg. Together, the doctors questioned whether the cosmetic medicine known as BOTOX and used by many dermatologists including Reichenberg to treat frown lines between the eyebrows could help in treating depression.

“Botullin intoxin causes the nerve to not make the muscle move as much,”  Reichenberg explains about the popular procedure.

Mental health experts suggest frown lines are one indicator on your face that shows how one is feeling. Meaning we carry our emotions on our face by smiling when we are happy or frowning when we are sad. The doctors wondered if BOTOX could keep one from frowning less could it lead to less depression.

“We had to be careful, we didn’t want people who wanted free BOTOX, they had to be clinically depressed,” Reichenberg said.

“I felt different.”

The doctors chose 30 clinically depressed and first time BOTOX users including Brittany Whittenberg to be part of the study.

“When you are at your lowest point you’re willing to try anything,” Brittany says. She was diagnosed with major depression in 2011. She says her facial expressions of constantly frowning and furrowing her brows reflected how sad she felt on the inside.

“Maybe it’s something I do all the time. I don’t even know I’m doing it, it just happens. So maybe that’s making me approachable and people don’t feel comfortable approaching me,”  she said.

GOING IN-DEPTHKXAN News has found Botox/Botox Cosmetic are currently FDA approved for the following uses:

  • to treat leakage of urine (incontinence) in adults with overactive bladder due to neurologic disease
  • to prevent headaches in adults with chronic migraine who have 15 or more days each month with headache lasting 4 or more hours each day
  • to treat increased muscle stiffness in elbow, wrist, and finger muscles in adults with upper limb spasticity
  • to treat the abnormal head position and neck pain that happens with cervical dystonia in adults
  • to treat certain types of eye muscle problems (strabismus) or abnormal spasm of the eyelids (blepharospasm) in people 12 years and older
  • to treat the symptoms of severe underarm sweating (severe primary axillary hyperhidrosis) when medicines used on the skin (topical) do not work well enough
  • to improve the look of moderate to severe frown lines between the eyebrows (glabellar lines) in adults for a short period of time (temporary)
    to improve the look of crow’s feet lines in adults for a short period of time (temporary).

The 24-week-long study was as follows: For 12 weeks, 19 patients received a placebo injection, 11 patients received BOTOX injections in the forehead. The doctors studied the patients’ symptoms of depression then switched the groups at 12 weeks and studied the patients for the remainder of the 6-month-long study.

Patients were allowed to stay on previously prescribed psychiatric medications, the BOTOX was an added treatment. However, four patients were not taking any medication at the time and the BOTOX injections were the sole treatment.

“I felt different,” says Brittany, who was in the first group to receive the BOTOX injections. She says she looked and felt a significant difference, less depressed.

“Something is changing the brain.”

The doctors say the results of the study were “pleasantly surprising,” according to Dr. Magid. “What we found was in the botulinum toxin (BOTOX) group there was a 42-percent reduction in depression symptoms. Whereis in the placebo there was a 15-percent reduction.”

While the doctors were intrigued with the results they were also looking for answers as to exactly how the BOTOX can change a depressed patient’s mood.

“That’s the big question and we don’t necessarily agree on it,” says Reichenberg.

The doctors say there are two theories as to why BOTOX may lead to less depression. Dr. Reichenberg’s theory is biological.

“If you are thinking of botullum toxin (BOTOX) as depressing the nerve activity just to these specific muscles then your brain doesn’t feel it that you are frowning.” He adds, “your brain stops having that feedback and there are actual chemical changes that reduce all the signs of depression and anxiety.”

Dr. Magid suggests the effects are more of a social theory.

“The more you smile, the happier you feel. The more you frown the sadder you feel. So it’s not the other way around, it’s not that you frown because you’re sad. It might be you’re sad because you frown,” Magid argues.

Whatever the reason, the doctors hope for a bigger study to catch the attention of the Food and Drug Administration which can ultimately approve the use of BOTOX to treat depression, doing so would clear the way for insurance coverage for the nearly $300 treatment.

A spokesperson for the FDA tells KXAN News “information about plans to seek FDA approval for additional uses of Botox would need to be addressed by the drug company. Under the law we are not able to disclose that information.”

The makers of BOTOX have not responded to KXAN’s request for information.

In May, the doctors’ research study was published in the Journal of Clinical Psychiatry. 

The doctors are hopeful and say the results show while the cosmetic effects of BOTOX usually wear off in 3-4 months, patients in their study felt less depressed for as long as six months.

“Something is changing the brain to keep the antidepressant effects going even though the cosmetic effects wear off,” adds Dr. Magid. That finding brings a smile to Brittany’s face, “the idea of helping my mood and helping me through a major depressive episode is definitely very hopeful.”

Patients looking for more information on the survey can learn more on the doctors’ website.

We wanted to know about potential side effects of Botox; The Mayo Clinic says the treatment is relatively safe when performed by an experienced doctor.

The most common side effects are swelling or bruising at the injection site, sometimes headache or flu-like symptoms.

If the injections are in the wrong place, the Botox could spread to other areas, causing eyelid droop, cockeyed eyebrows, a crooked smile, dry eye or excessive tearing.

And while it’s very unlikely, there is a possibility that the Botox could further spread to other parts of the body, causing muscle weakness, vision problems, trouble speaking or swallowing, trouble breathing, and loss of bladder control.

Doctors also say you shouldn’t use Botox when you’re pregnant, because it’s unknown how it could affect the baby.

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