Recharge Medical Blog

Recharge Medical
Philippe T. Nguyen

Philippe T. Nguyen, MD
Chief Medical Officer

Can Botox treat Depression?

the word smile superimposed on a non-smiling woman

Recent evidence suggests yes

Botulinum toxin A (Botox®) has been used to smooth wrinkles and to effectively treat muscle spasms, migraine, and urinary incontinence. Botox works by creating temporary muscle paralysis. Injected into the forehead muscles above and between the eyebrows, Botox improves the appearance of frown lines. Recent evidence suggests that this same Botox injection might also be an effective treatment for depression.

A growing body of research shows that a single Botox treatment between the eyebrows may produce a strong and sustained reduction of depressive symptoms. This seems to occur in both patients who did not improve sufficiently on medications and patients that have never been treated with antidepressive medication. The symptom reduction takes effect about two weeks after one treatment and continues long after the cosmetic effect of Botox has worn off.*

How? Two theories emerge

The fact that the antidepressive effect continued after the wrinkles reappeared suggests that the elevated mood is not just a byproduct of the cosmetic improvement or the self esteem boost that might come from having fewer wrinkles. There are two theories for Botox antidepressive effects:

Botox treatment changes people’s social experience and make it harder for patients to frown. As WebMD science writer Jim Kling writes, “If individuals smile more and frown less, they are likely to have better social experiences, which could lift mood.”

The far more likely explanation is biologic. Dr. Tillman Kruger explains that our emotions are expressed by facial muscles. Those facial expressions in turn send feedback signals to the brain to reinforce our emotions. Treating facial muscles with Botox might interrupt this cycle resulting in improved mood.

Medical imaging studies have shown that when people are unable to make angry facial expressions there is less activity in the area of the brain that controls emotions like anxiety and fear. If a person cannot frown, the brain does not register a frown, and the brain does not understand that the person is upset, thereby leaving the person in a better mood. Ever hear the phrase “smile until you’re happy”? It’s the same principle.

This idea is not new

For many years research has pointed to the role of facial expressions in the physiology of emotions and the treatment of mood disorders. Facial expression of negative emotions such as fear, sadness, and anger all involve contraction of the muscles in the forehead, and multiple lines of evidence specifically implicate the forehead muscles in depression.

Another method to treat depression

The more we learn more about the connections between our bodies and our emotions, the more we see that entirely new approaches to treating mood disorders are helpful. For example, light therapy is now standard treatment for seasonal affective disorder (SAD). Having another treatment to ease depression, especially since Botox does not conflict with antidepressant medication, will be very helpful.

Currently in Phase II studies

Although researchers across the globe are looking at Botox as a treatment for depression, using botox to treat depression is still off-label (experimental). However, the makers of Botox are already in Phase II clinical studies for FDA approval of Botox in the treatment of depression. So, it could become a standard treatment soon. In the meantime, who wouldn’t benefit from smoothing away a few wrinkles? And if it improves your mood at the same time, that’s all the better!

Image: Alan Cleaver, Smile, Creative Commons CC by 2.0. Botox is a registered trademark of Allergan, Inc.

* Your results may vary.


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