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BACKGROUND Major depression is a common and serious disease that may be resistant to routine pharmacologic and psychotherapeutic treatment approaches.

OBJECTIVE To evaluate the efficacy of botulinum toxin A treatment of glabellar frown lines in treating patients with major depression, using a small open pilot trial.

METHODS Patients who met DSM-IV criteria for ongoing major depression in spite of pharmacologic or psychotherapeutic treatment were evaluated with the Beck Depression Inventory II (BDI-II) before receiving botulinum toxin A to their glabellar frown lines. Two months later, all patients were re-evaluated clinically and with the BDI-II.

RESULTS Ten depressed patients were treated with botulinum toxin A, and 9 of 10 patients were no longer depressed 2 months after treatment. The tenth patient had an improvement in mood.

CONCLUSION To our knowledge, these are the first reported cases of depression treated with botulinum toxin A.