Odd Drug Therapies for Depression in the News – Botox, Ketamine

Two stories about drug research studies showed up in my “Depression” Google news alert this week. Both struck me as very odd.

The first involved using Botox to beat back depression. A study to be published in an upcoming issue of Journal of Psychiatric Research found Botox injections surprisingly successful in decreasing depression. This article by health journalist Sharon Kirkey explains the study.

Researchers who injected Botox into the corrugator and procerus muscles — the pyramid-shaped “frown muscles” between the eyebrows — in people suffering major depression found that, six weeks after a single treatment, more than half (52 per cent) of patients given Botox reported significant and sustained improvements in mood, compared to 15 per cent of patients injected with salt water.

Botox is most commonly used as a beauty aid, to smoothe wrinkles and temporarily disguise signs of aging. The researchers don’t understand exactly how or why Botox would work on depression. This article explains the theory behind the research study and includes some speculation by the researchers.

The research is premised on a theory of emotion first proposed by Charles Darwin and William James, the “father” of American psychology, that facial expressions feed information back to the brain and affect how people feel emotionally.

Darwin believed the severely depressed suffered from hyperactive corrugator muscles. He called them the “grief muscles.”

The new study pushes the “facial feedback hypothesis” further. Frowning requires contraction of the corrugator muscles. The researchers thought, why not paralyze these muscles with Botox? Making it harder for people to frown, they reasoned, could reduce distress signals to the brain.
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According to [researchers] Finzi and Rosenthal, “frowning may affect the way people feel about themselves when they look in the mirror and the way others respond to them.” “Happier” facial expressions may lead to “more positive social interactions,” they added.

They also believe the brain continuously monitors facial expressions, “and that the mood responds accordingly.” Freezing the frown muscles with Botox may interrupt that circuitry.

Has anyone ever told you to “turn that frown upside down” when you were depressed? If so, you probably felt the urge to punch whoever said that. But if this research is correct, willing yourself to smile or even paralyzing your face to render it incapable of frowning may actually work.

This sounds patently ridiculous to me. Then again, plenty of legitimate scientific theories sound ridiculous to laypersons when first proposed. I don’t plan to experiment with Botox anytime soon, but I look forward to reading about further research. And maybe I’ll try some smile therapy.

The second research study involved treating depression with ketamine, an anesthetic with hallucinogenic properties. A research study led by an Oxford psychiatrist was published recently in the Journal of Psychopharmacology.

McShane and his colleagues treated 28 patients who had severe treatment-resistant depression for several years with either three or six ketamine infusions over three weeks, and monitored their moods for six months.

A third of the patients showed improvement as soon as three days after the last infusion, with effects lasting anywhere from 25 days to eight months. Four of those patients are continuing ketamine treatment, and one has reported no symptoms of depression even after having been taken off the treatment.

This isn’t the first study on treating depression with ketamine. Previous studies at the Mayo Clinic and Yale School of Medicine showed similar success.

Ketamine has some underground popularity as a street drug or club drug. I’ve never tried it, whether in authorized or unauthorized circumstances, and I don’t plan to try it unless and until the science becomes much more solid. But the research does sound promising.

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