Psychiatrists to start using Botox for depression?

[Anasazi23]

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What do you think?

While it's only in the pilot phase, it looks like it may be promising.

It would be a great procedure for us.
😎

http://www.chron.com/disp/story.mpl/health/3877521.html

 

[Poety]

What do you think?

While it's only in the pilot phase, it looks like it may be promising.

It would be a great procedure for us.
😎

http://www.chron.com/disp/story.mpl/health/3877521.html

Makes sense, considering the act of smiling releases endorphins to improve our mood. I read a study once that also showed the happiest people were the ones that smiled all the time... good thing I love to smile! 😀 🙂 😀 🙂 😀 🙂

Sazi, think we could get in on giving the injections? woooo hoooo "lie on the couch, I'm going to inject you now"

 

[Anuwolf]

You've got to be kinding, right?!?!??!?!?!?

 

[Anasazi23]

Makes sense, considering the act of smiling releases endorphins to improve our mood. I read a study once that also showed the happiest people were the ones that smiled all the time... good thing I love to smile! 😀 🙂 😀 🙂 😀 🙂

Sazi, think we could get in on giving the injections? woooo hoooo "lie on the couch, I'm going to inject you now"

I had heard this this was in the work for psychiatry over a year ago. I'm very glad to see it coming to the forefront now. There's no reason that psychiatrists wouldn't be able to use and administer this procedure if it's deemed FDA approved at some point.

 

[PublicHealth]

What would William James think?

Isn't he the one who said that we're happy because we smile, and sad because we frown?

 

[Triathlon]

You've got to be kinding, right?!?!??!?!?!?

We are doctors you know. We have all done many injections, cut, sutured, taken part in many a delicate surgery, and much more. Or do you mean botox as a treatment option. I'm sure that's it right.

 

[sdn1977]

I had heard this this was in the work for psychiatry over a year ago. I'm very glad to see it coming to the forefront now. There's no reason that psychiatrists wouldn't be able to use and administer this procedure if it's deemed FDA approved at some point.

You don't need special FDA approval to obtain it. Its already an approved drug. As a physician, you can prescribe/use it label or off-label & your specialty doesn't preclude that. I don't know anything about your billing though....I'm speaking strickly from the perspective of a pharmacist in obtaining the drug...not the ethics or scope of practice in using it.

 

[Anasazi23]

You don't need special FDA approval to obtain it. Its already an approved drug. As a physician, you can prescribe/use it label or off-label & your specialty doesn't preclude that. I don't know anything about your billing though....I'm speaking strickly from the perspective of a pharmacist in obtaining the drug...not the ethics or scope of practice in using it.

I was more referring to billing purposes. Plus, it's always nice, if you're going to be injecting a powerful neuromuscular blocker into the faces of people, to have FDA approval. It's not like we're giving topirimate for weight loss.
😉

It's not unheard of for psychiatrists to use botulism toxin in severe cases of dystonia. Neurologists do this quite often.

 

[Anuwolf]

We are doctors you know. We have all done many injections, cut, sutured, taken part in many a delicate surgery, and much more. Or do you mean botox as a treatment option. I'm sure that's it right.

I can imagine now… watching Judge Judy on TV and a Botox commercial comes up but their not talking about cosmetic procedure, they discuss how their produce can cure depression ( they show old people walking on beaches happy) and how their product is number one (they show kids jumping up and down and running up to their grandparents or parents and smiling). Why don’t they say that the blue pill cures depression, at least it gives men another thing to think of besides depression, eh?!?

 

[Solideliquid]

If there is a "study" in progress my mom wants to sign up!


Take it easy Anuwolf, you have a lot to learn about medicine and psychiatrists.

 

[Anuwolf]

If there is a "study" in progress my mom wants to sign up!

Take it easy Anuwolf, you have a lot to learn about medicine and psychiatrists.

It doesn’t take a rocket scientist to figure out that the last thing people need is to be taking is a botox pill (or injection) to become happy. I mean why cant people have more sex (safe sex) or masturbate more often? Out of all of the psychiatrists that I’ve ever went to over the past years… not one had told me “I think you need to enjoy your sex life more often and think of how good you feel when doing it” sex can be a powerful tool if used properly.

Can you imagine how many people would be abusing this kind drug? Just say chaos in the cosmetic community. It’s bad enough that this drug are in the hands of uncertified people who claim to be doctors.

As far As learning about psychiatrist, I know plenty about them.. Just remember that I am a patient, been thru TONS of psychiatrists thru my childhood until now.

I admit that I’m still trying to learn about Medicine. That’s why I’m here to learn 😀

 

[Anasazi23]

It doesn’t take a rocket scientist to figure out that the last thing people need is to be taking is a botox pill (or injection) to become happy. I mean why cant people have more sex (safe sex) or masturbate more often? Out of all of the psychiatrists that I’ve ever went to over the past years… not one had told me “I think you need to enjoy your sex life more often and think of how good you feel when doing it” sex can be a powerful tool if used properly.

Can you imagine how many people would be abusing this kind drug? Just say chaos in the cosmetic community. It’s bad enough that this drug are in the hands of uncertified people who claim to be doctors.

As far As learning about psychiatrist, I know plenty about them.. Just remember that I am a patient, been thru TONS of psychiatrists thru my childhood until now.

I admit that I’m still trying to learn about Medicine. That’s why I’m here to learn 😀

This doesn't really.....make sense. We're talking about injections here, and the mechanisms of action and the psychological implications are deeper than it appears on the surface.

Remember that this a forum for medical students, psychiatry residents and psychiatrists. Comments like, "have more sex" are likely not going to be met with great acceptance. It's ok to browse and read, but be wary of posting lots of comments about processes that are way ahead of your knowledge base.

 

[Poety]

It doesn’t take a rocket scientist to figure out that the last thing people need is to be taking is a botox pill (or injection) to become happy. I mean why cant people have more sex (safe sex) or masturbate more often? Out of all of the psychiatrists that I’ve ever went to over the past years… not one had told me “I think you need to enjoy your sex life more often and think of how good you feel when doing it” sex can be a powerful tool if used properly.

Can you imagine how many people would be abusing this kind drug? Just say chaos in the cosmetic community. It’s bad enough that this drug are in the hands of uncertified people who claim to be doctors.

As far As learning about psychiatrist, I know plenty about them.. Just remember that I am a patient, been thru TONS of psychiatrists thru my childhood until now.

I admit that I’m still trying to learn about Medicine. That’s why I’m here to learn 😀

Anu, I'm sorry, but this in no way makes you an authority on psychiatry. In fact, as a patient I think your ideas may be a bit skewed. Just a thought. I'm not saying you don't understand therapy or lack insight, but I definitely don't think you have enough knowledge to comment on the mechanism/action, etc of medications, nor would you be able to comment on their efficacy in any area of medicine.

 

[Psyclops]

It doesn’t take a rocket scientist to figure out that the last thing people need is to be taking is a botox pill (or injection) to become happy. I mean why cant people have more sex (safe sex) or masturbate more often? Out of all of the psychiatrists that I’ve ever went to over the past years… not one had told me “I think you need to enjoy your sex life more often and think of how good you feel when doing it” sex can be a powerful tool if used properly.

And it can have an enourmously powerful influence if used improperly. Regardless of mechanism of action, sexual intercourse would be considered in my book to be a very dirty drug. By dirty drug, I would mean that it would be affecting more systems than it was intending to treat.

 

[OldPsychDoc]

Just something more to think about... 🙂

This study suggests that the "little blue pill" seems to have some anti-depressant qualities!
CONCLUSIONS: Men treated with sildenafil for ED demonstrated improved erectile function and an increased intercourse success rate, which correlated positively with improvement in SEAR measures of self-esteem and sexual relationship. (Emphasis mine).

 

[Psyclops]

Self-esttem is an interesting concept. I tend to see it as a reward our system employs when we do well. Although many see it as the causal factor for doing well. To some extent that could be true, in that if you feel worthless you may not have the wherewithal to try to acheive anything. Generally though I see it as the result not the cause of acheivement.

 

[MissMuffet]

I mean why cant people have more sex (safe sex) or masturbate more often? ... “I think you need to enjoy your sex life more often and think of how good you feel when doing it” sex can be a powerful tool if used properly.

Can you imagine how many people would be abusing this kind drug? Just say chaos in the cosmetic community.

Something about that just tickles me. 😉


(Not that the role of a healthy sex life and how the subject is approached in therapy wouldn't be an interesting discussion, though. 🙂 )

 

[Smilemaker100]

What do you think?

While it's only in the pilot phase, it looks like it may be promising.

It would be a great procedure for us.
😎

http://www.chron.com/disp/story.mpl/health/3877521.html

There has been talk of dentists employing botox and perhaps doing face lifts. After all, we sort of are "head and neck" specialists.

http://news.bbc.co.uk/2/hi/uk_news/england/london/3537919.stm

http://www.webmd.com/content/article/114/111175.htm

A number of patients with facial pain syndromes suffer from depression (psychiatry reference here for those who may not see the relevance). In fact, some dentists suggest prescribing minimal doses of anti-depressants for some facial pain conditions.

Some have even suggested the use of botox for those suffering from bruxism (tooth grinding habit).

http://jada.ada.org/cgi/content/abstract/131/2/211

Taken from the American Dental Association (ADA) Website:

"Recent articles from The New York Times , WebMD , and Health Day News report that Botox (botulinum-A neurotoxin) may be effective in treating patients with trigeminal neuralgia, based on the findings of a small, unblinded pilot study in the October 25 issue of Neurology. 1

Trigeminal neuralgia, or tic douloureux, is an intense facial pain caused by irritation of the trigeminal nerve, a cranial nerve with sensory branches that pass through the face and jaw. Current treatment options for trigeminal neuralgia include anticonvulsant medications such as carbamazepine (Tegretol) or phenytoin (Dilantin), which are not always effective and have side effects, and surgical interventions.

In the published study, a Brazilian and American research team investigated the therapeutic use of Botox in 13 patients with trigeminal neuralgia. Ten days post-treatment, the patients reported significant reductions in pain and most were reportedly symptom-free after 20 days. Sixty days after treatment, four patients no longer required preventive medication, and the others had their medication reduced by more than half.

Although the results of this pilot study are promising, large-scale randomized clinical trials on the therapeutic use of Botox for trigeminal neuralgia are needed to confirm the results, determine the duration of the effects, and more carefully assess any adverse events. As noted by the study authors, a placebo-controlled clinical trial is required to confirm their results. This is consistent with the findings of a recent systematic review, which identified no randomized controlled trials in this area and presented no definitive conclusions on administering Botox for the treatment of rare head and neck pain syndromes. 2

The ADA has not taken a specific position on dentists administering Botox; however, a number of state dental boards have or are in the process of developing policy for its use. All dentists who are considering using Botox for treatment of dental conditions should consult their state dental board to determine if this falls within the scope of practice in their respective state and, if so, what specific requirements are necessary."

Endnotes

1 Piovesan EJ, Tieve HG, Kowacs PA, Della Coletta MV, Werneck LC, Silberstein SD. An open study of botulinum-A toxin treatment of trigeminal neuralgia. Neurology 2005;65:1306-1308.

2 Sycha T, Kranz G, Auff E, Schnider P. Botulinum toxin in the treatment of rare head and neck pain syndromes: a systematic review of the literature. J Neurol. 2004 Feb;251 Suppl 1:I19-30

 

[Solideliquid]

Makes sense, considering the act of smiling releases endorphins to improve our mood. I read a study once that also showed the happiest people were the ones that smiled all the time... good thing I love to smile! 😀 🙂 😀 🙂 😀 🙂

Sazi, think we could get in on giving the injections? woooo hoooo "lie on the couch, I'm going to inject you now"

..."directly into the brain".

I wonder you can get the same anti-depression effects by injecting into other parts of the face/head?

 

[soaringheights]

So if this treatment is shown to be really effective, will it overtake pharmaco n psychotherapy in the treatment of depression? Would u guys use it as the 1st line of treatment?

 

[Solideliquid]

So if this treatment is shown to be really effective, will it overtake pharmaco n psychotherapy in the treatment of depression? Would u guys use it as the 1st line of treatment?

No, even in the article that dermatologist restricted botox usage to patients whom were already being treated for depression with unchanged symptoms for three months.

So it would probably not be a 1st line treatment, but might by an augmentation of other 1st line treatments.

 

[Triathlon]

So if this treatment is shown to be really effective, will it overtake pharmaco n psychotherapy in the treatment of depression? Would u guys use it as the 1st line of treatment?

Most likely not, standard of care wouldn't support it in court following a suicide/ attempt. If it actually works then eventually it may be a tx for mild depression?? alone.

 

[Psyclops]

Anyone think there will be an increase in maligereing of depression just so they can get third party reimbusement of Botox?

 

[PublicHealth]

There are more than twice as many posts in this thread than there were subjects in that study! There's a reason why it's published in "Dermatologic Surgery" and not a psychiatry journal.

I strongly suspect that cue response mediates botox treatment effectiveness in depression. For example, some people are more sensitive to what their bodies are doing and others are more sensitive to their environment. In many cases, depression has a clear trigger. These triggers may arise from either source. An RCT with several arms -- botox, SSRI, CBT, etc -- is the ultimate test of whether botox actually works relative to conventional treatments. Throw in a measure of cue response style as well.

Matching patients to depression treatment is something that we'll likely see more of in the future: http://www.ncbi.nlm.nih.gov/entrez/...uids=16585452&query_hl=15&itool=pubmed_docsum

 

[Anasazi23]

I'd rather see late 30's and 40's women malingering for botox than late 20's, 30's, 40's, 50's and 60's drug addicts malingering for xanax.

🙂

 

[Poety]

I'd rather late 30's and 40's women malingering for botox than late 20's, 30's, 40's, 50's and 60's drug addicts malingering for xanax.

🙂

👍

 

[Triathlon]

I'd rather late 30's and 40's women malingering for botox than late 20's, 30's, 40's, 50's and 60's drug addicts malingering for xanax.

🙂

Heck yeah, billing for botox would make it worth it to me. Malinger on, as long as you pay me.