Botulinum toxin, also known as Botox, is commonly used to remove wrinkles by temporarily paralysing facial muscles. But according to some studies, Botox can also be used to treat depression. This article details some of these studies and what they have found.

Darwin’s facial feedback hypothesis

Charles Darwin said: “The free expression by outward signs of an emotion intensifies it. On the other hand, the repression, as far as is this is possible, of all outward signs, softens our emotions.” In other words, facial activity can have an effect on emotions. Darwin argued that smiling makes a person feel better, rather than smiling being simply the result of feeling good. On the other hand, frowning will make you feel sad. Some studies have tested the hypothesis that Botox can help with these aspects of emotional processing.

Studies on Botox and depression

The first study was published in 2006 in the Journal of Dermatological Surgery by Eric Finzi, a dermatologist and face expert who first came up with the idea of using Botox to treat depression. His own mother suffered from depression and whilst painting portraits of women who were institutionalised in France, he saw the resemblance between the unhappy faces of these women and that of his mother.

As a result, Finzi wondered about the connection between expression and feeling – particularly between expression and depression. He considered whether medically preventing sad expressions will in fact prevent sad feelings. He also thought about Darwin’s facial feedback hypothesis concerning emotions not being as strong or not persisting for long if you’re not expressing those feelings on your face.

In 2003, Finzi tested the facial feedback hypothesis together with depression treatment. He treated several people suffering from depression with Botox, paralysing their eyebrow muscles that create expressions of sadness, anger and fear. The result was that 9 out of the 10 patients studied reported a complete remission of their depression, providing proof for Finzi’s theory that paralysing the eyebrows would help eliminate or decrease depression.

In a second study, researchers from the Hannover Medical School in Germany found that using Botox to treat facial muscles involved in emotion helps to alleviate depressive symptoms. For patients who received Botox treatment for glabellar frown lines, their mood became more positive.

Another study, published in the Journal of Psychiatric Research in May 2014, was randomised, double-blind and placebo-controlled. The 30 patients studied had major depression and were resistant to antidepressant medications. Those in the treatment group were given a dose (which consisted of five injections) of Botox in their eyebrow area, while members of the control group were given saline placebo injections. For the treatment group, depressive symptoms decreased by 47.1% (according to the 17-item Hamilton Depression Rating Scale) after six weeks, and it stayed this way for the rest of the 16-week study period. For the placebo group, there was only a 9.2% reduction in symptoms.

The study showed that treating facial muscles with Botox interrupts the facial feedback to the brain, which in turn prevents the facial muscles from registering negative emotions. It supports the idea that facial muscles not only express mood states, but they also regulate them. This is a good thing for people who are resistant to antidepressants, making Botox an effective and economical tool for the treatment of major depression.

Modifying the brain’s neural process

Another German study by Andreas Hennenlotter confirmed this with the use of fMRI imaging to measure the activity of the brain before and after injecting Botox to suppress smiling muscles. The study showed that facial feedback modifies the brain’s neural process of emotional content in a way that one’s spirit lifts up when they smile.

Fortunately, these studies have supported Darwin’s facial feedback hypothesis, meaning that there is now a new, much-needed and welcomed treatment for depression.

Dr Mark Kohout

Dr Mark Kohout is a plastic surgeon with over 18 years of experience. With a fellowship at two of the most prestigious surgical colleges in Great Britain, a Master of Surgery Degree from Melbourne and Harvard Medical School specialty training, Dr Mark Kohout is one of the best in his industry.

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