Michelle Magid, MD Clinical Assistant Professor Texas A&M Health Science Center Round Rock, Texas Clinical Assistant Professor University of Texas Galveston, Texas Adjunct Faculty Department of Psychiatry University of Texas Dell Medical School at Seton Family of Hospitals Austin, Texas
Jason Reichenberg, MD Associate Professor Department of Dermatology University of Texas Dell Medical School at Seton Family of Hospitals Austin, Texas
Summing up Botulinum toxin for depression is not ready for prime time. The FDA has not approved its use for psychiatric indications, and Medicare and commercial insurance do not reimburse for this procedure as a treatment for depression. Patients who request BTA for depression must be informed that this use is off-label.
For now, we recommend psychotherapy or medication management, or both, for most patients with major depression. In addition, until larger studies are done, we recommend that patients who are interested in BTA for depression use it as an add-on to conventional treatment. However, if larger studies replicate the findings of the smaller studies we have described, botulinum toxin could become a novel therapeutic agent in the fight against depression.
Bottom Line In pilot studies, botulinum toxin A (BTA) has shown efficacy in improving symptoms of depression. Although considered safe, BTA is not FDA-approved for psychiatric indications, and Medicare and commercial insurance do not reimburse for this procedure for depression. Larger studies are underway to determine if this novel treatment can be introduced into practice.
Related Resources • Wollmer MA, Magid M, Kruger THC. Botulinum toxin treatment in depression. In: Bewley A, Taylor RE, Reichenberg JS, et al, eds. Practical psychodermatology. Hoboken, NJ: John Wiley & Sons; 2014:216-219. • Botox for depression. www.botoxfordepression.com. • Botox and depression. www.botoxanddepression.com.
Drug Brand Names Botulinum toxin A • Botox Citalopram • Celexa
Acknowledgments We thank the Brain and Behavior Research Foundation for granting Dr. Magid a young investigator award and for continuing to invest in innovative research ideas. We thank Dr. Eric Finzi, MD, PhD, Axel Wollmer, MD, and Tillmann Krüger, MD, for their continued collaboration in this area of research.
Disclosures In July 2011, Dr. Magid received a young investigator award from the Brain and Behavior Research Foundation for her study on treating depression using botulinum toxin (Grant number 17648). In November 2012, after completion and as a result of the study on treating depression using botulinum toxin, Dr. Magid became a consultant with Allergan to discuss study findings. In September 2015, Dr. Magid became a speaker for IPSEN Innovation. Dr. Reichenberg is married to Dr. Magid. Dr. Reichenberg has no other conflicts of interest to disclose.
