Botulinum Toxin as a Treatment for Depression in a Real-world Setting

J Psychiatr Pract. 2018 Jan;24(1):15-20. doi: 10.1097/PRA.0000000000000277.


Objectives: A series of randomized controlled trials have shown the efficacy of glabellar botulinum toxin (BTX) injection as a treatment for depression in women. We wanted to extend these findings and assess how they may be translated to a real-world setting.

Methods: For that purpose, 42 patients with severe, in most cases chronic and treatment-resistant depression received adjunctive treatment with BTX in private practice. Depression severity was rated before and 3 weeks after the treatment using the Hamilton Depression Rating Scale, the Montgomery ├ůsberg Depression Rating Scale, and the Beck Depression Inventory.

Results: Almost all of the patients improved clinically, with depression scores dropping by 27% on all 3 scales in the sample as a whole. These changes were highly significant (P<0.001, paired t test or Wilcoxon test) and the absolute prepost score differences were similar to those observed in previous randomized controlled trials. Importantly, treatment effects did not differ between male (n=23) and female (n=19) patients.

Conclusions: These findings suggest that glabellar BTX injection may also be effective in the treatment of severe depression and in the treatment of depression in men, when treatment is carried out not just in clinical trials but in real-world settings.

MeSH terms

  • Adult
  • Antidepressive Agents / pharmacology*
  • Botulinum Toxins, Type A / administration & dosage
  • Botulinum Toxins, Type A / pharmacology*
  • Depressive Disorder, Major / drug therapy*
  • Depressive Disorder, Treatment-Resistant / drug therapy*
  • Drug Therapy, Combination
  • Female
  • Forehead
  • Humans
  • Male
  • Neuromuscular Agents / administration & dosage
  • Neuromuscular Agents / pharmacology*
  • Treatment Outcome


  • Antidepressive Agents
  • Neuromuscular Agents
  • Botulinum Toxins, Type A
  • onabotulinum toxin A