The Treatment of Depression With Botulinum Type A Toxin

Inclusion Criteria

• Male/Female between the ages of 18 and 65
• Major Depression Disorder as defined by DSM IV criteria and diagnosed by a psychiatrist. DSM (Diagnostic and Statistical Manual) 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
• History of depression for at least 6 months
• Initial score 14 or higher on initial Hamilton Depression rating scale.
• 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

• Active substance abuse
• Bipolar Depression
• Subjects who are pregnant, nursing or trying to become pregnant during study participation
• Subjects who are currently on more than 3 psychiatric medications at the time of enrollment
• Current medications used to treat depression must be stable for at least 60 days prior to enrollment
• Previous Botox treatment
• 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.