The Treatment of Depression With Botulinum Type A Toxin

A 24-week Randomized, Double-blind study treating people who suffer from depression who also have moderate to severe frown lines in forehead region with Botox injections. Subjects participating will have their photos taken and complete a questionnaire regarding their depression. They will see a psychiatrist at every visit who will assess their depression.

• Drug: Clostridium botulinum toxin type A neurotoxin complex
  Botulinum Toxin Type A: Neurotoxin Complex
  Other Name: Clostridium Botulinum Toxin Type A: Neurotoxin Complex
• Other: 0.9% NaCl solution
  0.9% NaCl Solution: Placebo Comparator
  Other Name: 0.9% NaCl solution B. Braun

• Active Comparator: Botox
  clostridium botulinum toxin type A neurotoxin complex: Experimental A total of 29-40 U of clostridium botulinum toxin type A neurotoxin complex (Allergan) will be injected in the glabella region according to standard protocols of cosmetic botulinum toxin applications.
  Intervention: Drug: Clostridium botulinum toxin type A neurotoxin complex
• Placebo Comparator: Placebo
  0.9% NaCl solution will be injected like the experimental compound
  Intervention: Other: 0.9% NaCl solution

Inclusion Criteria:

1. Male/Female between the ages of 18 and 65

2. Major Depression Disorder as defined by DSM IV criteria and diagnosed by a psychiatrist. DSM IV criteria for depression are: a depressed mood or anhedonia for at least a two week period. This mood must represent a change from the person's normal mood; social, occupational, educational or other important functioning must also be negatively impaired by the change in mood. Major depressive disorder cannot be diagnosed if a person has a history of bipolar disorder or if the depressed mood is better accounted for by substance abuse or a psychotic disorder. In addition, the patient must have 5 of the following symptoms:

   • Significant weight loss or weight gain.
   • Insomnia or hypersomnia
   • Psychomotor agitation or retardation
   • Feelings of worthlessness or excessive guilt
   • Poor Concentration
   • Fatigue or loss of energy
   • Suicidal thoughts
3. History of depression for at least 6 months
4. Initial score 14 or higher on initial Hamilton Depression rating scale.
5. Melancholic facial expressions amenable to treatment with Botox. Photos will be taken of potential participants and ranked independently by two investigators, on a scale of 1-10 based on how negative they look, 10 being the highest. Patients with an average score of 6 or above will be included in the study

Exclusion Criteria:

1. Active substance abuse
2. Bipolar Depression
3. Subjects who are pregnant, nursing or trying to become pregnant during study participation
4. Subjects who are currently on more than 3 psychiatric medications at the time of enrollment
5. Current medications used to treat depression must be stable for at least 60 days prior to enrollment
6. Previous Botox treatment
7. The Principle Investigator has determined that this study is not in the best interest of the subject and therefore the subject will not be enrolled.