Original Research ARTICLE
Agitation predicts response of depression to botulinum toxin treatment in a randomized controlled trial
- 1Asklepios Clinic North – Ochsenzoll, Asklepios Campus Hamburg, Medical Faculty, Semmelweis University, Hamburg, Germany
- 2Psychiatric Clinics of the University of Basel, Basel, Switzerland
- 3Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Hannover, Germany
- 4Department of Psychiatry, University of Texas Southwestern at Seton Family of Hospitals, Austin, TX, USA
- 5Department of Dermatology, University of Texas Southwestern at Seton Family of Hospitals, Austin, TX, USA
In a randomized, controlled trial (n = 30), we showed that botulinum toxin injection to the glabellar region produces a marked improvement in the symptoms of major depression. We hypothesized that the mood-lifting effect was mediated by facial feedback mechanisms. Here we assessed if agitation, which may be associated with increased dynamic psychomotor activity of the facial musculature, can predict response to the treatment. To test this hypothesis, we re-analyzed the data of the scales from our previous study on a single item basis and compared the baseline scores in the agitation item (item 9) of the Hamilton Depression Rating Scale (HAM-D) between responders (n = 9) and participants who did not attain response (n = 6) among the recipients of onabotulinumtoxinA (n = 15). Responders had significantly higher item 9 scores at baseline [1.56 + 0.88 vs. 0.33 + 0.52, t(13) = 3.04, d = 1.7, p = 0.01], while no other single item of the HAM-D or the Beck Depression Inventory was associated with treatment response. The agitation score had an overall precision of 78% in predicting response in a receiver operating characteristic (ROC) analysis (area under the curve, AUC = 0.87). These data provide a link between response to botulinum toxin treatment with a psychomotor manifestation of depression and thereby indirect support of the proposed facial feedback mechanism of action. Moreover, it suggests that patients with agitated depression may particularly benefit from botulinum toxin treatment.
Keywords: psychomotor agitation, major depressive disorder, type A botulinum toxins, randomized controlled trial, personalized medicine
Citation: Wollmer MA, Kalak N, Jung S, de Boer C, Magid M, Reichenberg JS, Brand S, Holsboer-Trachsler E and Kruger THC (2014) Agitation predicts response of depression to botulinum toxin treatment in a randomized controlled trial. Front. Psychiatry 5:36. doi: 10.3389/fpsyt.2014.00036
Received: 19 February 2014; Paper pending published: 25 February 2014;
Accepted: 18 March 2014; Published online: 31 March 2014.
Edited by:Roumen Milev, Queen’s University, Canada
Copyright: © 2014 Wollmer, Kalak, Jung, de Boer, Magid, Reichenberg, Brand, Holsboer-Trachsler and Kruger. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: M. Axel Wollmer, Asklepios Clinic North – Ochsenzoll, Langenhorner Chaussee 560, Hamburg 22419, Germany e-mail: email@example.com