It could potentially help alleviate mental health symptoms for millions.
Botox has become something of a bad word. Normally, when we hear it, we think of celebrities with overly tight faces and swollen lips, who are called out in the tabloids as having “work done.” But, slowly, as more and more people open up about their “work,” the quick and easy treatment is becoming less taboo. (Of course, it’s really nobody’s business what others decide to do to their faces.) In fact, Botox might be getting a bit of a makeover as new research shows it can be used to treat conditions that are more than skin-deep.
Botulinum toxin injections — which is the long, medical way to say Botox — smooth out wrinkles by relaxing the muscles in your face and temporarily preventing them from moving. Now, scientists are looking into whether this mechanism can help alleviate a range of mental health conditions, including depression and anxiety.
Of course, some research is more optimistic than others. According to findings published in the journal Toxins in June 2023, 53 percent of the men and women with depression who received botox injections saw a significant improvement in their symptoms.
Others remain skeptical. Currently, the use of botox for psychological disorders has not been approved by the Food & Drug Administration, despite efforts by drugmakers.
Amid these burgeoning findings, we decided to dig a little deeper to separate fact from fiction when it comes to the benefits of Botox beyond blemishes.
What is Botox and is it good for your mental health?
Botulinum toxin type A is an injectable neurotoxin that’s probably better known under brand names such as Botox, Dysport, Xeomin, and Jeuveau.
The medicine in these injections is made from the same toxin that causes a type of food poisoning called botulism. But don’t worry, it won’t make you sick: Forms of purified botulinum toxin used by licensed healthcare providers meet medical control standards and receive federal approval.
While we tend to think of Botox as an anti-aging treatment, it wasn’t originally intended for cosmetic use. The FDA first approved it in 1989 to treat people with crossed eyes and rare eye muscle disorders. Since then, doctors have used it to treat a myriad of other conditions, including everything from chronic migraines and excessive sweating to painful involuntary neck contractions.
As one of the most heavily researched drugs in the world, it’s currently spurring all kinds of research into whether it might have other benefits, specifically when it comes to mental health. And so far, it’s looking relatively promising: A 2021 study from the University of California San Diego found that anxiety was 22 to 72 percent lower in patients treated with Botox.
Botox might also be helpful for depression. After mining FDA data of nearly 40,000 people, researchers found that people who received botox injections reported depression significantly less frequently than patients undergoing different treatments for the same conditions, according to findings published in the journal Scientific Reports.
While compelling, these findings aren’t new. In 2006, 10 patients with major depression were injected with botulinum toxin A in their frown lines, and 9 of 10 patients reported no longer being depressed two months after receiving treatment. (As for the tenth patient, they saw an improvement in their mood.) “To our knowledge, these are the first reported cases of depression treated with botulinum toxin A,” researchers stated in the study, which was published in the journal Dermatologic Surgery.
How does Botox help treat depression?
Specifically, the idea of utilizing botulinum toxin A to treat mental health disorders is primarily based on what’s known as the “facial feedback hypothesis,” which suggests that our emotional experiences are influenced by our facial expressions. For example, smiling typically makes us feel happier while frowning can make us feel more sad.
The theory was first developed by evolutionary biologist Charles Darwin and the “father” of American psychology William James in the 19th century. While we typically use facial expressions to signal how we’re feeling to others, they can influence how we feel ourselves. In many cases, this self-reflection can reinforce negative thoughts and feelings.
Temporarily blocking the action of these grief muscles could make people feel better, and even reverse depression.
So, what we’re saying is that Botox can almost literally turn your frown upside down by preventing you from making the exaggerated sad face — and that’s a good thing for your mood. (It might explain why your neighbor or favorite reality star whose face doesn’t move seems to always be in a great mood.) By halting the negative emotional feedback that frowning sends to the brain, experts believe Botox may be useful in the treatment of mood disorders and depression. Psychiatrist Norman Rosenthal, MD has published his own work on supporting this theory.
“Since the time of Darwin, scientists have targeted the frown muscles between the eyebrows as so-called grief muscles,” Dr. Rosenthal told Katie Couric Media. “In addition, many researchers have suggested that these muscles not only reflect grief but propagate it. If that is true, temporarily blocking the action of these grief muscles could make people feel better, and even reverse depression.”
Why are some experts skeptical about using Botox to treat depression?
Before you go making an appointment with your dermatologist to treat your depression, you should know that evidence for this hypothesis has been mixed, at best. An international team of experts decided to look into it and ultimately concluded in a 2022 paper published in the journal Nature Human Behavior that smiling can actually make us happier, but the effect wasn’t strong enough to overcome serious mental health conditions like depression.
“We experience emotion so often that we forget to marvel at just how incredible this ability is,” led researcher Nicholas Coles told Stanford News.
Jeff Larsen, a professor of psychology at the University of Tennessee, has collaborated with Coles in analyzing some of the studies on the subject and they believe the evidence so far is likely too good to be true.
For one, Larsen points out that placebo effects aren’t being controlled for in these studies because saline injections don’t have a noticeable effect on patients’ appearances and their ability to contract their facial muscles, therefore the patient pretty much knows whether or not they got the botox injection. “Facial feedback effects are too weak,” Larsen says. “They have a tiny effect on our emotional state.”
What are the potential risks and benefits of using Botox for depression?
The ability to treat patients without the usual antidepressants could be potentially life-changing for approximately 280 million people who are suffering from depression worldwide. Common treatments for depression aren’t effective for nearly one-third of these people, even when they stick to their treatment plans.
There are even some findings that show using botulinum toxin A might be more beneficial, in some ways, than traditional antidepressants. A 2021 study in the journal Brain and Behavior found that those with depression who received botulinum toxin A injections into their frown-related muscles reduced the severity of their depression compared to those who took the antidepressant sertraline (commonly known as Zoloft). What’s more, the injections helped improve mood faster and there were fewer side effects than with the oral medication.
Another unexpected result is that botulinum toxin injections may have a positive ripple effect on other people. Research described in the Journal of Cosmetic Dermatology suggests that when botulinum toxin injections soften someone’s frown lines or the “11s” between their eyebrows, it can alter the way other people respond to them — namely, by reducing their negative emotions. Think of it as quite literally spreading joy.
It seems like magic to me and in science, we don’t do magic.
The downside is these injections don’t treat the underlying problem of depression, which experts say has more to do with cognitive distortions than symptoms themselves. The most common form of distorted thoughts is an exaggerated thought pattern that’s not based on facts and can lead to negative thinking. For instance, someone might immediately jump to the conclusion that someone’s ignoring them if they don’t greet them swiftly with enthusiasm.
“I have a hard enough time seeing how Botox affects the symptom, but how it could possibly touch the actual causes of the illness,” says Larsen. “It seems like magic to me — and in science, we don’t do magic.”
Another drawback is that the mood-enhancing effects of botulinum toxin injections aren’t permanent. On average, dermatologist Shana Marmon, MD, says Botox typically lasts around three months, and “the effects last even longer in less active locations like the forehead or between the eyebrows,” she says. “In areas with more frequent muscle movement, such as around the mouth or crow’s feet, the treatment will wear off quicker because the body’s metabolism of the neurotoxin will be increased.” So, if this was your only method of warding off depression, hypothetically, you might need to get it pretty frequently.
It’s also worth noting that these injections aren’t generally covered by insurance, though some plans have some exceptions. (Meanwhile, antidepressants often are covered by insurance.) That means that they can come with a hefty price tag: Injections of 30 units of botulinum toxin can cost up to $500, but some think it’s worth it. Dr. Rosenthal says he got some Botox last winter and he believes it really helped with his seasonal depression. “I felt quite cheerful and euphoric afterward,” he tells us.
Ultimately, he hopes that provided more research, Botox will become a viable option for those struggling with their mental health. “Oftentimes when you’re treating depression, you have to combine different treatments — and when people think of combining different treatments, they think narrowly simply of combining different medicines,” he says. “But really, I would like people to think more broadly, not only about medicines but about alternative options as well.”
