Botox Depression Treatment: Our Take on the New Trend

Off-label uses for Botox: depression, migraines, and more


As Drs. P K Nigam and Anjana Nigamhave pointed out, Botox currently boasts off-label uses including management of many conditions, including

  • Improper alignment of both eyes
  • Involuntary, irregular muscle contractions in the facial muscles
  • Headaches
  • Excess production of saliva
  • Excessive and unpredictable sweating

In fact, the FDA approved Botox for treatment of these conditions in 1989 – many years before approving the injections for use as a cosmetic treatment in 2002.

More recently, in 2010, Botox was approved for use as a treatment for chronic migraines. And doctors first began experimenting with Botox for depression relief as early as 2006.

Allergan, the Botox manufacturer, continues to look for new uses for the injections – for conditions as wide-ranging as cerebral palsy and premature ejaculation.

Research shows an effective treatment option in Botox for depression

While medical and psychiatric professionals have been looking into Botox as a potential treatment for drug-resistant depression since 2006, it wasn’t until this most recent round of studies that researchers had had enough data to draw credible, accurate conclusions – and, of course, there’s still work to be done before Botox gets FDA approval for this new use. Here’s what researchers have found so far:

2006: An observant dermatologist heard from several of his patients that they were feeling better mentally and emotionally after having Botox injections. He set up a small pilot study with 10 volunteers who reported themselves as depressed. (The doctor confirmed this by having volunteers fill out a depression survey and attend interviews with a psychologist, who confirmed that all participants were legitimately depressed.) The dermatologist administered Botox to all the participants – who were all women – and had them come back to his office 2 months later. Nine out of the 10 women showed significant improvement in their depression. (The tenth woman’s condition had improved, but she still showed some symptoms of depression.)

Susan Brink, a reporter at the LA Times, explained her take on the results to Madeleine Brand of NPR:“[A] more solid theory is that it’s sort of like a societal reaction. When you smile people smile back at you. When you frown people frown back at you. And there’s a social feedback loop that is triggered by your facial expressions. … .. If you were walking around with a hangdog look on your face and slumped shoulders … you’re not very inviting to talk to, to interact with. And, in fact, part of cognitive therapy is -involves teaching people to get rid of that hangdog look.”

2012: M. Alex Wollmer, a psychiatrist at the University of Basel in Switzerland, led a study that attempted to determine whether or not Botox could be an effective treatment option for patients whose condition had shown no response to antidepressants. His team found that, 6 weeks after a single dose of Botox administered above the eyebrows and on the forehead, patients’ depression (as measured by the Hamilton Depression Rating Scale) had reduced by an average of 47.1 percent. In patients who received placebo injects, depression had reduced by an average of 9.2 percent.

But Wollmer thinks there’s more to the results than the idea that our facial expressions can actually influence our emotions. Tori Rodriguez of Scientific American puts it this way: Our bodies also identify and experience the emotions that we come into contact with – and Botox impairs our ability to interpret and respond to negative emotions, which, in turn, decreases our experiences of these emotions.

2013: Dr. Eric Finzi made waves in the world of psychiatry with his study: he used more subjects, diversity among subjects was greater, and the remission of depression symptoms was more clearly illustrated.  Finzi organized a double blind, randomized, placebo-controlled experiment: 85 subjects with clinically diagnosed major depression were randomly selected to receive either one dose of Botox or one dose of saline injections into the sites of frown muscles. The research team collected data and ratings about the subjects at the time of injection, 3 weeks later, and 6 weeks after.

Finzi and his research team found some pretty interesting results:  After 6 weeks, the group that received the placebo injections had shown an average 9% improvement in their depression as scored by the Montgomery-Asberg Depression Rating Scale (MADRS); the group that received Botox showed an average 47% improvement.

After the trial, Finzi and his team tested for compromised results due to patients knowing whether they’d received Botox or a placebo. But as it turned out, the results weren’t affected by whether or not subjects could tell which treatment they’d had.

Why is Botox for depression treatment so effective?

Early research pointed to the idea that, when we feel more attractive, we tend to feel happier; in theory, you’d feel more attractive after a Botox treatment. But as more and more medical professionals jumped on board with the Botox and depression connection, that hypothesis evolved into something more complex.

Darwin actually beat us to it: he proposed that our facial muscles and our emotions participate in one another’s functions. The simple version: when we feel sad, we frown; and when we frown, it makes us feel sad.

Modern physicians and researches build on Darwin’s theory. Richard A. Friedman, professor of clinical psychiatry at Weill Cornell Medical College, explains it this way:

“The Botox studies … suggest a circuit between the brain and the muscles of facial expression in which the brain monitors the emotional valence of the face and responds by generating the appropriate feeling. (Obviously, information flows in both directions, as you can think yourself into practically any emotional state and then have the face to match it.)”

When you paralyze frown muscles with Botox, you dampen the muscles’ ability to communicate with the brain. And when you do this to the specific muscles that we use to express negative emotions, you decrease the frequency  – maybe even the ease – with which you really feel those emotions.

The Takeaway: Our opinion on Botox for depression treatment

Patrick Bowler, MD points out that Botox can do a bit of damage along with alleviating depression: it can affect a patient’s ability to empathize and communicate effectively with others. If someone is seeking relief from depression – a condition in which many people find themselves withdrawn from friends and family and having difficulty connecting with others – then the dampening effect of Botox might do more harm than good.

But, for someone experiencing mild to moderate depression, a Botox session could be a game-changer. Unlike some antidepressants, Botox – when properly administered by a certified, experience physician – is very safe, has no worrisome side effects when properly administered, and can be fairly cost-effective compared to monthly refills of brightly colored, brand-name pills.

Cognitive therapists employ the DIY version of what Botox enforces: they train patients to influence their brain’s activity by behaving in certain ways (smiling even if you don’t feel like it, for example).  Botox injections certainly promote this method, but they don’t require conscientious behavior on the patient’s part.

If you’re interested in Botox solely for its psychological benefits, perhaps your best (that is, most effective in the long term and truly treating underlying issues rather than just symptoms) option would be to begin cognitive therapy and use Botox as a supplemental treatment – training wheels, if you will. Because inhibiting the activity of emotive muscles can also inhibit your ability to communicate and empathize effectively, you’ll want to find a treatment or method that encourages you to work on empathy.  

Botox injections have only been shown to be effective for people with mild to moderate depression who weren’t reacting to antidepressants – not for those with severe depression. If you’re suffering from severe depression, you’ve already heard plenty of times that in-depth, long-term therapy is probably the most effective option.

In our opinion, though, if you’re already open to Botox, why not get the most feel-good bang for your buck? Enhance your appearance, boost self-esteem, and help your body retrain your mind to feel better – for a long time.  

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