Going out of the box

Despite it being a serious problem, not many are aware about depression and/or seek help for it nor many speak about it. As per the World Health Organisation (WHO) report of 2015, new global health estimates on depression suggests that over five crore Indians suffer from depression. With such alarming figures on the rise, scientists and researchers are exploring new ways to treat this condition. One such way is using Botox to treat depression.

What researchers say...

The use of Botox in cosmetic procedures to temporarily improve wrinkles, ageing skin is widely known. Medically speaking, it is also used for treating severe underarm sweating, chronic migraine in adults, upper limb spasticity, bladder incontinence to name some. Some researchers opine that Botox may help treat depression by blocking facial expressions that send signals being sent to the brain that cause low mood.

Last month, multinational pharmaceutical giant Allergan announced the results of its clinical trial assessing Botox in depression were sufficiently encouraging to move the treatment on to the next stage of development. Dr Eric Finzi, Chevy Chase Cosmetic Center, Maryland, US, said, “Our hope is eventually it will form a place as one of the tools to treat depression.”

Expert speak

Delhi-based senior consultant neuro-psychiatrist Dr Sanjay Chugh has been using Botox injections to treat depression for about 12 months now. “I first read about it in some scientific journals and on exploring further, found that it possibly had great relevance for a certain percentage of the patients visiting me,” he says. So far, he has administered Botox to about 100 patients having psychiatric problems like Obsessive Compulsive Disorder (OCD) besides depression.

Not a standalone tool 

If you thought that merely taking Botox jabs is going to kiss depression goodbye, then you’re wrong. Dr Chugh has used Botox treatment in patients who have not responded to conventional methods of treatment. However, after seeing the very gratifying results with this modality, he has started recommending it as initial treatment for depression along with medication. He always used Botox in conjunction with at least one other therapeutic modality.

Mumbai-based psychiatrist and psychotherapist Dr Anjali Chhabria too, has been using Botox as an adjunct treatment in depression for over a year now. “Research suggests that Botox has been used worldwide to treat depression and hence, we brought it to our clinic, Mindtemple, for clients and use it alongside other treatment plans such as rTMS (Repetitive Transcranial Magnetic Stimulation), tDCS (Transcranial Direct Current Stimulation), pet therapy and psychodrama,” says adding that she does not refer clients to cosmetologists as she has an expert who comes to the clinic and administers the Botox injections. 

However, this is not the first line of treatment as it is used in addition to medications and psychotherapy. She explains, “The first line of treatment is normally medication for depression and when there is no positive result seen within three to six weeks then we try and use other additional treatment. Sometimes, people come to us with resistant depression when they have tried medication for a long time and it’s not helping enough. At this point, we would add any other treatment and Botox is one of them. We also use this for people who want to recover faster.”

Where is Botox injected and who can administer it?

The injections to treat depression are given in the area called the Glabella, which is the area between the two eyebrows. Five sites are chosen carefully and accurately measured doses are given using a very fine needle, informs Dr Chugh. So can any mental health expert administer Botox injection for treating depression? “Not a psychologist but a psychiatrist, being a medical doctor is qualified to administer Botox injections. Nowadays, Botox is routinely used by different medical specialists,” he says.

Outcome

It is important to note that Botox is not some kind of a sure shot magic potion to treat depression. Dr Chhabria explains, “Botox isn’t magic as it is one more way of treating depression. We usually see difference in around two to three weeks of administering the treatment. But I will still emphasise on the fact that it is used in adjunct to other therapies and not used in isolation.” Dr Chugh would expect to see improvement in signs and symptoms of depression to start in two to three weeks after administration of the injections.

Sceptic speak

Dr Abhijit Desai, cosmetic dermatologist and laser specialist, founder, Skinsense — Skin and Laser Clinic, adds that pharmaceutical companies keep doing newer clinical trials to study the use and effectiveness in more and more medical conditions. “It’s a bit early to say that it is effective in treating depression as it has to get USA FDA approvals. FDA is a very stringent body and will only approve its use in treating depression only when all the aspects are studied carefully. I personally feel unless there is FDA approval one should not use it in commercial practice. As the patients should not be subjected to even the slightest risk,” he adds.