BOTOX and Depression…Really??

Learning to smile more and frown less.

Can the expressions on our face affect our mood? Well yes according to some recent studies. Smiling more and frowning less may be an additional treatment for long term treatment resistant depressive symptoms.

“Our emotions are expressed by facial muscles, which in turn send feedback signals to the brain to reinforce those emotions. Treating facial muscles with botulinum toxin (BOTOX) interrupts this cycle,” study investigator Prof. Tillmann Kruger said at a press conference at the American Psychiatric Association’s 2014 Annual Meeting.

While the use of BOTOX to treat depression is a relatively recent concept, research and findings relating facial expression to mood regulation date back to Charles Darwin and William James. Back in 1890 they developed the facial feedback theory, stating that facial expressions influence mood.

Intuitively it makes sense that if we smile more and frown less we might just feel happier. Conversely if we frown more we may feel feelings of sadness more often and more strongly. We are finding out that our feelings are actually connected to the muscles in our foreheads.

To oversimplify: While you may frown when you are sad, the act of frowning may actually make you sad.

And so it follows that if we could turn off or weaken the “frowning muscles “ in our face; we could in fact help create a better mood, or stop a bad one.

According to researchers at the Psychiatric Hospital of the University of Basel, Switzerland and the Department of Psychiatry, Medical School Hannover, Germany The answer is yes . These researchers found that BOTOX can be used to alleviate depression by injecting the frowning muscles of the face.

In a study published in the journal of Psychiatric Research involving 30 patients, scores on a standard depression rating scale were reduced on average by 47% for the patients who were given the BOTOX injection. The placebo group experienced only a 9% reduction in the scores related to their depression. All of the subjects in this study had been suffering from chronic clinical depression, an average 16 years of recurrent episodes with the current episode lasting almost 30 months.

These results were achieved after six weeks with just one injection in two small facial muscles commonly referred to as the frowning muscles. The two small muscles of the face considered the “frowning muscles” are the Procerus and the Corrugator (pictured below). The Procerus muscle helps pull the skin between the eye brows downwards while the Corrugator draws the eyebrow down and toward the center of the face. The Corrugator is often considered the principal muscle in suffering.

When these muscles contract a frown is observed. A frown (pictured below) is typically associated with feelings sadness or anger.

When these muscles are injected with BOTOX with small, diluted amounts controlled weakening of the muscles is observed. BOTOX works by preventing release of acetylcholine from nerve endings, leading to muscle paralysis. (result pictured below)

In essence BOTOX makes you stop scowling, which directly relieves your depression through feedback loop from the facial muscles to the brain. In fact, one published in the Journal of Clinical Psychiatry found that not only did Botox help with depression, but the effects continued even after the cosmetic changes wore off.1

According to the Centers for Disease Control and Prevention (CDC), between 2009 and 2012, 7.6% of people 12 and older suffered from depression. The National Institute of Mental Health (NIMH) says women are 70 percent more likely to suffer from depression in their lifetimes. For some who have tried therapy, antidepressants, alternative treatments and lifestyle changes to no avail, BOTOX may be the answer. Currently BOTOX is used off-label for depression, however it is in phase 2 clinical trials for FDA approval for use in this area.


BOTOX has a number of additional clinical uses, some of which are listed below:

3• Cervical dystonia. Neck muscles contract involuntarily causing your head to twist or turn into an uncomfortable position.
• Lazy eye. Commonly caused by an imbalance in the muscles responsible for positioning the eye, resulting in crossed eyes.
• Muscle contractures. Some neurological conditions, such as cerebral palsy, can cause your limbs to pull in toward your center. Some conditions related to muscular spasm after a cerebral vascular event. In some cases, these contracted muscles can be relaxed with botulinum toxin injections.
• Hyperhidrosis. In this condition, excessive sweating occurs even when the temperature isn’t hot and you’re not exercising. In some people, the sweat literally drips off their hands.
• Chronic migraine. If you experience migraines more than 15 days a month, botulinum toxin injections may help reduce headache frequency.
• Bladder dysfunction. Botulinum toxin injections can also help reduce urinary incontinence caused by an overactive bladder.

If you or someone you know is interested in using BOTOX for depression or other conditions please do not hesitate to contact us for a private consultation.

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