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Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin

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Directly acting muscle relaxants like dantrolene and botulinum toxin (BoNT) have distinct mechanisms and applications. Dantrolene, a hydantoin derivative, acts on the ryanodine receptor (RYR1) in skeletal muscle cells. RYR1 are calcium channels present at the sarcoplasmic reticulum membrane. In response to excitation, they release calcium ions from the sarcoplasmic reticulum to the cytosol. Calcium promotes actin-myosin-mediated contraction of muscles.
The binding of dantrolene to the RYR1...

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MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder

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OnabotulinumtoxinA in Resistant Depression: A Randomized Trial Comparing Two Facial Injection Sites (OnaDEP Study).

Caroline Ceolato-Martin¹, Claire Chevallier-Collins², Jean-Pierre Clément^1,3,4

¹Esquirol Hospital, University Centre for Adult and Elderly Psychiatry and Addictology, 15 Rue du Dr Raymond Marcland Limoges, Limoges 87000, France.

Depression and Anxiety

|April 14, 2025

Summary

This summary is machine-generated.

OnabotulinumtoxinA injections in the glabella area show promise for treating major depressive disorder (MDD). This study found glabella injections more effective than crow

Keywords:

agitation botulinum toxin A depression melancholic omega neuromodulation: amygdala

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Area of Science:

Neuroscience
Psychiatry
Pharmacology

Background:

OnabotulinumtoxinA (OnaA) injections in the glabella area are being explored as a novel treatment for major depression.
Ensuring adequate blinding in placebo-controlled trials of botulinum toxin is a significant challenge.

Purpose of the Study:

To evaluate the efficacy of OnabotulinumtoxinA (OnaA) injected into the glabella versus the crow's feet area for treating resistant major depressive disorder (MDD).
To assess the impact of blinding in botulinum toxin studies for depression.

Main Methods:

A randomized trial involving 58 patients with resistant MDD, all receiving active OnaA.
Participants were randomized to receive OnaA injections in either the glabella (N=29) or crow's feet (N=29) area.
Subjects and the examining clinician were blinded to the injection site; primary outcome was responder rate (≥50% MADRS decrease) at week 6.

Main Results:

A significantly higher proportion of responders was observed in the glabella group (44.8%) compared to the crow's feet group (17.9%; p=0.029).
Higher scores on item 9 of the Hamilton Depression Rating Scale (HAM-D), indicating psychomotor agitation, predicted a positive treatment response.

Conclusions:

OnabotulinumtoxinA (OnaA) injections in the glabella muscles represent an effective and well-tolerated treatment for major depressive disorder (MDD).
Patients with high HAM-D item 9 scores may constitute a subgroup that responds best to this treatment.
The mechanism may involve modulation of sensorimotor cortex and amygdala activity.