The Treatment of Depression With Botulinum Type A Toxin

Participants will be assigned to receive either placebo or botulinum toxin injections in the
forehead

Inclusion Criteria:

1. Male/Female between the ages of 18 and 65

2. 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

3. History of depression for at least 6 months

4. Initial score 14 or higher on initial Hamilton Depression rating scale.

5. 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:

1. Active substance abuse

2. Bipolar Depression

3. Subjects who are pregnant, nursing or trying to become pregnant during study
participation

4. Subjects who are currently on more than 3 psychiatric medications at the time of
enrollment

5. Current medications used to treat depression must be stable for at least 60 days prior
to enrollment

6. Previous Botox treatment

7. 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.