From the Department of Surgery, Division of Plastic Surgery, University of California, San Diego School of Medicine; and Larner College of Medicine, University of Vermont.
Plast Reconstr Surg. 2022 Jul 1;150(1):211e-220e. doi: 10.1097/PRS.0000000000009240. Epub 2022 May 20.
Depression is a leading cause of disability worldwide. Preliminary evidence suggests that glabellar onabotulinumtoxinA injections improve depression scores with few side effects compared to current first-line antidepressant medications. The authors' review reports on these studies, hypothesizing that glabellar onabotulinumtoxinA injections can be an alternative safe and effective treatment for depression.
A systematic review and meta-analysis of the relevant literature was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Cochrane Library, Embase, and Scopus databases were searched in August of 2020 using the keywords ["botox" OR "botulinum"] AND ["mood" OR "depression"] for articles published between 1980 and 2020. Prospective studies and randomized controlled trials on the use of glabellar onabotulinumtoxinA injections for the primary purpose of treating depression were considered. The primary endpoint for the meta-analysis was the mean difference in primary depression scores after treatment, along with a second endpoint of the standardized mean difference in depression scores among treated patients including all nine studies.
Of the 499 reviewed articles, nine studies were included that reported improvement in mean depression scores from baseline. All five randomized controlled trials reported an improvement in mean depression scores at 6 weeks after treatment, with a weighted average change of -8.39 points ( p < 0.0001). The aggregate standardized mean difference from baseline to the primary endpoint across all nine prospective studies was -1.61 SD ( p < 0.0001).
Meta-analysis and systematic review of the included studies provide support for an antidepressant effect of glabellar onabotulinumtoxinA injections.
抑郁症是全球导致残疾的主要原因。初步证据表明，与当前一线抗抑郁药物相比，眉间注射肉毒毒素 A 可改善抑郁评分，且副作用较少。作者的综述报告了这些研究，假设眉间注射肉毒毒素 A 可作为一种替代的安全有效的抑郁症治疗方法。
根据系统评价和荟萃分析的首选报告项目，对相关文献进行了系统评价和荟萃分析。2020 年 8 月，使用“肉毒杆菌毒素”或“肉毒杆菌”和“情绪”或“抑郁”等关键词，在 PubMed、Cochrane 图书馆、Embase 和 Scopus 数据库中搜索了 1980 年至 2020 年期间发表的文章。考虑了将眉间肉毒毒素 A 注射作为主要目的治疗抑郁症的前瞻性研究和随机对照试验。荟萃分析的主要终点是治疗后主要抑郁评分的平均差异，以及包括所有 9 项研究在内的治疗患者抑郁评分的标准化平均差异的第二个终点。
在 499 篇综述文章中，有 9 项研究报告了基线时抑郁评分的改善。所有 5 项随机对照试验均报告了治疗后 6 周时平均抑郁评分的改善，加权平均变化为-8.39 分（p<0.0001）。9 项前瞻性研究中从基线到主要终点的总标准化平均差异为-1.61 标准差（p<0.0001）。
纳入研究的荟萃分析和系统评价为眉间肉毒毒素 A 注射具有抗抑郁作用提供了支持。
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