Can Botox Treat Depression?

The common thought has always been that when we feel various emotions such as anger, fear, or sadness that we express these emotions on our face after we feel them, but what if it works the other way around too? Is it possible that our facial expressions may also regulate our emotions?

We have all been told to smile because the act of smiling can actually make us happier, so it might be possible that frowning also makes us sad. If we can block the muscles from creating  the frown can we also stop the feelings associated?

Let’s take a closer look at depression, how Botox (Botulinum Toxin A) might treat it and what the evidence says.

Depression is a common mood disorder characterized by feelings of sadness or hopelessness as well as poor motivation. It can have multiple physical and mental effects and is typically treated with cognitive behavioral therapy (CBT) and anti-depressant medications. Signs and symptoms of any of the following, lasting more than 2-weeks, may indicate depression (not an all inclusive list):

• Sad feelings or depressed mood
• Loss of interest or lack of pleasure in activities previously enjoyed
• Weight loss or gain not associated with diet or exercise; changes in appetite
• Difficulty sleeping or sleeping more than usual
• Fatigue and decreased energy
• Feeling guilty or worthless
• Difficulty concentrating, thinking or making decisions
• Suicidal ideation or thoughts of death

Botox is one of many brand names for Botulinum Toxin A, which is an injectable medication used to temporarily paralyze muscles resulting in a reduction of fine lines and wrinkles when used cosmetically. Common areas treated in the face are the forehead, the glabellar region (the 11’s lines between the eyes), and crow’s feet.

Botulinum Toxin A is also used to treat a variety of medical disorders including chronic migraine, eye spasms, and over-active sweat glands. Other common types of Botulinum Toxin A also include Xeomin and Dysport. Read this article to learn more about Botox, Xeomin and Dysport.

The physical and cosmetic effects of this medication are obvious but incidentally researchers are discovering that there might be psychological benefits as well, and not just from improved appearance of wrinkles. There is emerging evidence showing that people who suffer from depression have improvement in their symptoms when they utilize Botulinum Toxin A to treat their glabellar lines, also called “frown lines” between the eyes.

The mechanism is thought to be from a feedback loop to the brain. Above it was mentioned how smiling can actually make you happy; this is by releasing chemical signals to the brain telling you you are happy. When you utilize the glabellar muscles it is typically with feelings such as anger, frustration or sadness. By blocking this movement it’s theorized that it may also block some of the negative emotions themselves.

• A 2006 case study by Finzi & Wasserman evaluated how effective Botulinum toxin A glabellar treatments were on patients with major depression. There were 10 participants treated and 9/10 were no longer depressed 2-months post treatment and the 10^th patient had improved mood.
• A 2012 randomized control trial (Wollmer et. al) showed that a single treatment with Botulinum toxin in the glabellar region created a strong and sustained relief of depression in patients who had not improved adequately on other medications. The study supported the idea that facial muscles do not only control expression but also regulate mood.
• Hexel et. al. (2013) studied changes with depression and self-esteem before and after glabellar treatment in patients with and without depression. They found a significant improvement in symptoms after treatment with maximum effect 8-weeks after treatment.
• Magid et. al. (2014) discovered in a 24-week randomized, double-blind, placebo-controlled study that Botulinum toxin A injected in the glabellar region significantly improved depression symptoms when compared to placebo and was also found to be safe. They also found that the improved mood continued even after the cosmetic effects wore off.
• Another randomized 2014 study by Finzi & Rosenthal with 85 participants with major depressive disorder (MDD) found a 52% improvement in patients with Botulinum toxin A treatment versus 15% for placebo. They also achieved remission in the treatment group of 27% versus 7% for placebo. These outcomes were achieved after only one treatment to the glabellar region.
• In a 2017 randomized clinical trial Zamarian et. al. compared patients being treated with Botox vs placebo and found a statistically significant difference in the treatment group at week 6 but no difference at baseline and week 2 post treatment. They determined that Botox is effective and has a high safety profile for patient with major depression.
• In a 2018 review study on glabellar botulinum toxin for major depressive disorder (MDD) Stearns et. al. reviewed 6 studies and scored them based on quality. They found that botulinum toxin injections are a promising treatment for MDD but that more high quality studies are needed.

There are many additional studies on Botulinum Toxin A and depression as well as for depression associated with Bipolar disorder, chronic migraine and other co-morbidities that all look promising. Allergan is also in phase II clinical trials to get FDA approval for the use of Botox to treat depression.

• Botox, orBotulinum Toxin A, may work in treating depression by inhibiting the muscle movement in the face that occurs with feelings such as anger, fear or sadness and therefore assist in regulating these emotions.
• This effect appear to be independent of the cosmetic effect which is an improvement in wrinkles, though many patients also report improved self-esteem with or without underlying depression.
• Botulinum Toxin A for the treatment of depression is very promising and it will be interesting to see the results of the phase II clinical trials by Allergan.
• Overall much more research is needed but it is an added bonus if treating the glabellar region for cosmetic purposes may also help create more happiness in a patient’s life.

It is important to note that this is not yet an approved treatment for depression and if you do this procedure you should not discontinue your medications or other therapies if you suffer from depression.

It is always advised to talk to your primary care provider (PCP) before trying any new treatment, medically and cosmetically.

If you are located in the Lone Tree, CO area, and would like to schedule a free consultation with Ali, NP or one of the providers at Elite Medical and Aesthetics, click the button below!

• Finzi, E., Wasserman, E. (2006). Treatment of Depression with Botulinum Toxin A: A Case Series. Dermatologic Surgery, 32(5),645-49.
• Finzi, E., & Rosenthal, N.E. (2014). Treatment of depression with onabotulinumtoxinA: a randomized, double-blind, placebo controlled trial. Journal of psychiatric research, 52, 1-6.
• Hexel, D., Brum, C., Siega, C., Schilling-Souza, J., Dal’Forno, T., Heckmann, M., Rodrigues, TC. (2013). Evaluation of self-esteem and depression symptoms in depressed and nondepressed subjects treated with onabotulinumtoxinA for glabellar lines. Dermatological Surgery, 39(7):1088-96.
• Magid, M., Reichenberg, J. S., Poth, P. E., Robertson, H. T., Laviolette, A. K., Kruger, T. H., & Wollmer, M. A. (2014). Treatment of Major Depressive Disorder Using Botulinum Toxin A. The Journal of Clinical Psychiatry, 75(08), 837-844.
• Stearns, TP., Shad, MU., Guzman, GC. (2018). Glabellar Botulinum Toxin Injections in Major Depressive Disorder: A Critical Review. Prim Care Companion CNS Disord.4;20(5)
• Wollmer MA, De boer C, Kalak N, et al. Facing depression with botulinum toxin: a randomized controlled trial. J Psychiatr Res. 2012;46(5):574-81.
• Zamanian, A., Ghanbari Jolfaei, A., Mehran, G., & Azizian, Z. (2017). Efficacy of Botox versus Placebo for Treatment of Patients with Major Depression. Iranian journal of public health, 46(7), 982-984.