Download PDF
Fortschr Neurol Psychiatr 2014; 82(2): 93-99
DOI: 10.1055/s-0033-1356093
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Botulinumtoxin bei der Behandlung depressiver Störungen

Eine systematische ÜbersichtBotulinum Toxin for the Treatment of Major Depressive DisorderA Systematic Review
A. E. Hawlik
1   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
,
R. W. Freudenmann
1   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
,
E. H. Pinkhardt
2   Klinik für Neurologie, Universitätsklinikum Ulm
,
C. J. Schönfeldt-Lecuona
1   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
,
M. Gahr
1   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
› Author Affiliations
Further Information

Publication History

Publication Date:
11 February 2014 (online)

    Permissions and Reprints

Zusammenfassung

Hintergrund: Botulinumtoxin (BTX) spielt bei der Behandlung und der Prophylaxe der chronischen Migräne eine wichtige Rolle und wird zudem bei der Behandlung fokaler Dystonien, von Spastik, Hypersalivation und bei Hyperhydrosis eingesetzt. Es wird auch eine antidepressive Wirkung von BTX-Injektionen in Muskelgruppen im Gesicht, die negative Emotionen ausdrücken, diskutiert. In dieser Übersichtsarbeit soll die derzeit verfügbare Evidenz im Hinblick auf eine antidepressive Wirkung von BTX vorgestellt und diskutiert werden.

Methoden: Mehrere Datenbanken wurden systematisch mit dem Suchterminus [(„botulinum toxin“ OR „botox“) AND („antidepressant“ OR „depression“ OR „depressed“)] durchsucht. Zudem wurde auf der Website www.clinicaltrials.gov nach gegenwärtig laufenden Studien geschaut.

Ergebnisse: Bis April 2013 wurden 3 Studien publiziert, die die antidepressive Wirkung von BTX-Injektionen untersuchten und nachweisen konnten: Eine Fallsammlung von 10 depressiven Patientinnen, denen BTX injiziert wurde; eine randomisierte, doppelblinde und placebokontrollierte Studie mit 30 an einer Depression erkrankten Probanden, die einer Verum- und einer Placebogruppe zugeteilt worden waren; eine prospektive, offene Studie mit je 25 depressiven und gesunden Probanden. Es fanden sich zudem 2 laufende Studien, die den antidepressiven Effekt dieser Therapie untersuchen.

Schlussfolgerungen: Die aktuell veröffentlichten Studien konnten eine Reduktion depressiver Symptome nach der Applikation von BTX in die Glabella zeigen. Weitere klinische Studien an größeren Kollektiven sind für den Nachweis der Wirksamkeit und Sicherheit von BTX-Injektionen bei der Behandlung depressiver Störungen notwendig.

Abstract

Objective: Botulinum toxin (BTX) plays an important role in the treatment and prophylaxis of migraine and is also used for the treatment of focal dystonia, spasm, hypersalivation, and hyperhydrosis. Recent clinical trials suggest that BTX treatment of muscles involved in the development of negative emotions may also have an antidepressant effect. This article gives a systematic review of the literature regarding BTX in the treatment of major depression.

Methods: We screened the databases of Medline and Scopus using the search terms [(“botulinum toxin” OR “botox”) AND (“antidepressant” OR “depression” OR “depressed”)]. The website www.clinicaltrials.gov was screened with the same search terms in order to detect current studies.

Results: As of April 2013, we identified 3 studies that evaluated the antidepressant effects of BTX in the treatment of major depression. An improvement in mood after treatment with BTX was seen in a case series of 10 depressed patients. In a randomised, placebo-controlled study of thirty patients assigned to a verum (BTX, n = 15) or placebo (saline, n = 15) group, treatment with BTX has also shown a positive effect on mood. Another prospective, open-label study evaluated the antidepressive effect of BTX in 25 subjects with major depression. On www.clinicaltrials.gov we identified 2 ongoing studies, which are currently investigating the antidepressant effect of BTX.

Conclusion: Recently published studies have shown a reduction of depressive symptoms after treatment of the glabellar frown lines with BTX injections. Further clinical studies in larger patient samples are necessary to prove the efficacy and safety of BTX injections used for the treatment of depressive disorders.

Schlüsselwörter

affektive Störungen - Glabella - Injektion - therapierefraktär

Key words

affective disorders - glabella - injection - therapy-refractory depression
 

  • Literatur

  • 1 Warden D, Rush AJ, Trivedi MH et al. The STAR*D Project results: a comprehensive review of findings. Curr Psychiatry Rep 2007; 9: 449-459
    CrossrefPubMedGoogle Scholar
  • 2 Gaynes BN, Warden D, Trivedi MH et al. What did STAR*D teach us?. Results from a large-scale, practical, clinical trial for patients with depression. Psychiatr Serv 2009; 60: 1439-1445
    PubMedGoogle Scholar
  • 3 Greden JF, Genero N, Price HL. Agitation-increased electromyogram activity in the corrugator muscle region: a possible explanation of the „Omega sign“?. Am J Psychiatry 1985; 142: 348-351
    PubMedGoogle Scholar
  • 4 Darwin C. The Expression of the Emotions in Man and Animals. London: Murray; 1872
    CrossrefGoogle Scholar
  • 5 Veraguth O. Die klinische Untersuchung Nervenkranker. Wiesbaden: JF Bergmann; 1911
    Google Scholar
  • 6 Strack F, Martin LL, Stepper S. Inhibiting and facilitating conditions of the human smile: a nonobtrusive test of the facial feedback hypothesis. J Pers Soc Psychol 1988; 54: 768-777
    PubMedGoogle Scholar
  • 7 Zajonc RB. Emotion and facial efference: a theory reclaimed. Science 1985; 228: 15-21
    CrossrefPubMedGoogle Scholar
  • 8 Larsen R. Facilitating the furrowed brow: an unobtrusive test of the facial feedback hyothesis applied to unpleasant affect. Cognition Emotion 1992; 6: 321-338
    CrossrefPubMedGoogle Scholar
  • 9 Heckmann M, Teichmann B, Schroder U et al. Pharmacologic denervation of frown muscles enhances baseline expression of happiness and decreases baseline expression of anger, sadness, and fear. J Am Acad Dermatol 2003; 49: 213-216
    CrossrefPubMedGoogle Scholar
  • 10 Davis JI, Senghas A, Brandt F et al. The effects of BOTOX injections on emotional experience. Emotion 10: 433-440
    PubMedGoogle Scholar
  • 11 Lewis MB, Bowler PJ. Botulinum toxin cosmetic therapy correlates with a more positive mood. J Cosmet Dermatol 2009; 8: 24-26
    CrossrefPubMedGoogle Scholar
  • 12 Hennenlotter A, Dresel C, Castrop F et al. The link between facial feedback and neural activity within central circuitries of emotion – new insights from botulinum toxin-induced denervation of frown muscles. Cereb Cortex 2009; 19: 537-542
    CrossrefPubMedGoogle Scholar
  • 13 Brin MF. Botulinum toxin: chemistry, pharmacology, toxicity, and immunology. Muscle Nerve Suppl 1997; 6: S146-S168
    PubMedGoogle Scholar
  • 14 Carruthers JD, Carruthers JA. Treatment of glabellar frown lines with C. botulinum-A exotoxin. J Dermatol Surg Oncol 1992; 18: 17-21
    CrossrefPubMedGoogle Scholar
  • 15 Carruthers A, Kiene K, Carruthers J. Botulinum A exotoxin use in clinical dermatology. J Am Acad Dermatol 1996; 34: 788-797
    CrossrefPubMedGoogle Scholar
  • 16 Jackson JL, Kuriyama A, Hayashino Y. Botulinum toxin A for prophylactic treatment of migraine and tension headaches in adults: a meta-analysis. JAMA 307: 1736-1745
    PubMedGoogle Scholar
  • 17 Frampton JE, Easthope SE. Botulinum toxin A (Botox Cosmetic): a review of its use in the treatment of glabellar frown lines. Am J Clin Dermatol 2003; 4: 709-725
    CrossrefPubMedGoogle Scholar
  • 18 De Boulle K, Fagien S, Sommer B et al. Treating glabellar lines with botulinum toxin type A-hemagglutinin complex: a review of the science, the clinical data, and patient satisfaction. Clin Interv Aging 5: 101-118
    PubMedGoogle Scholar
  • 19 Brin MF, Boodhoo TI, Pogoda JM et al. Safety and tolerability of onabotulinumtoxinA in the treatment of facial lines: a meta-analysis of individual patient data from global clinical registration studies in 1678 participants. J Am Acad Dermatol 2009; 61: 961-970 e961 – e911
    CrossrefPubMedGoogle Scholar
  • 20 Monheit GD, Cohen JL. Long-term safety of repeated administrations of a new formulation of botulinum toxin type A in the treatment of glabellar lines: interim analysis from an open-label extension study. J Am Acad Dermatol 2009; 61: 421-425
    CrossrefPubMedGoogle Scholar
  • 21 Wollmer MA, de Boer C, Kalak N et al. Facing depression with botulinum toxin: a randomized controlled trial. J Psychiatr Res 46: 574-581
    PubMedGoogle Scholar
  • 22 Finzi E, Wasserman E. Treatment of depression with botulinum toxin A: a case series. Dermatol Surg 2006; 32: 645-649 discussion 649 – 650
    CrossrefPubMedGoogle Scholar
  • 23 Hexsel D, Brum C, Siega C et al. Evaluation of Self-Esteem and Depression Symptoms in Depressed and Nondepressed Subjects Treated with OnabotulinumtoxinA for Glabellar Lines. Dermatol Surg 2013; 39: 1088-1096
    CrossrefPubMedGoogle Scholar
  • 24 Han C, Park GY, Wang SM et al. Can botulinum toxin improve mood in depressed patients?. Expert Rev Neurother 12: 1049-1051
    PubMedGoogle Scholar
  • 25 Young SN. Single treatments that have lasting effects: some thoughts on the antidepressant effects of ketamine and botulinum toxin and the anxiolytic effect of psilocybin. J Psychiatry Neurosci 37: 120-128
    PubMedGoogle Scholar
  • 26 Heckmann M, Ceballos-Baumann A. Botulinum toxin overrides depression: not surprising, yet sensational. Dermatol Surg 2007; 33: 765
    CrossrefPubMedGoogle Scholar
  • 27 Rief W, Nestoriuc Y, Weiss S et al. Meta-analysis of the placebo response in antidepressant trials. J Affect Disord 2009; 118: 1-8
    CrossrefPubMedGoogle Scholar
  • 28 Perlis RH, Ostacher M, Fava M et al. Assuring that double-blind is blind. Am J Psychiatry 167: 250-252
    PubMedGoogle Scholar