Botulinum toxin therapy of bipolar depression: A case series.

We and others have recently found that botulinum toxin injected into the brow muscles has significant antidepressant properties as compared to placebo in randomized controlled trials in patients with major depressive disorder. However, data for the treatment of bipolar depression with botulinum toxin is lacking. We report here six patients with bipolar disorder experiencing moderate to severe depressive episodes who were treated on a compassionate basis with botulinum toxin given their persistent depressive symptoms and adverse side effects from medications. Four of six patients with bipolar depression experienced a remission following treatment with botulinum toxin, and the other two patients experienced a reduction of depressive symptoms. When the effect of botulinum toxin on the frown muscles began to wear off, depressive symptoms returned and retreatment with botulinum toxin provided successful relief of depressive symptoms again.

Age bias: physical therapists and older patients.

The purposes of this study were to determine if, given a hypothetical patient description, physical therapists would establish the aggressiveness of treatment goals on the basis of the patient's age and to examine the relationship of both attitudes toward and knowledge about elderly adults to goal-setting aggressiveness for an elderly patient. Three questionnaires were administered to 127 therapists in clinical settings. Unbeknown to the therapists, half received a description in which the patient's age was 28 and the other half received a description of the same patient but with the age as 78. Therapists were significantly less aggressive in their goal setting with the elderly patient. Among therapists who received the old patient description, those with a more positive attitude were significantly more aggressive in goal setting for the elderly patient. Knowledge scores did not correlate with either aggressiveness or attitude in this group.