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Can Botox Beat Depression?

By keeping a smile on their faces, Botox users may have the last laugh

By Gary Drevitch

Making fun of people who have overdone it on Botox injections is a common theme of sitcoms and films, where characters desperate to fight off any signs of aging find themselves with frozen faces unable to frown, whether they are actually happy or not.

In reality, the effects of Botox are usually more subtle and, despite the jokes, there's no sign of the procedure's popularity declining: The American Society of Plastic Surgeons reports that of the 14.6 million cosmetic plastic surgery procedures performed in 2012 (both surgical and, like shots, minimally invasive) 6.1 million were Botox injections, a rise of 6 percent from the previous year.

(MORE: My One and Only Resolution: To Keep My Wrinkles)

And that somewhat frozen face may have a surprising health benefit, according to a study published in the Journal of Psychiatric Research. In a trial led by Dr. M. Axel Wollmer, a psychiatrist at the University of Basel, a group of people with major depressive disorder who had not responded to antidepressants were given a single series of Botox injections (five shots in all) while a control group was given placebo injections.

In the Botox group, symptoms of depression decreased 47 percent after six weeks, while the placebo group's symptoms declined only 9 percent. The treatment appeared to "interrupt feedback from the facial musculature to the brain, which may be involved in the development and maintenance of negative emotions," Wollmer told Scientific American.

(MORE: Expert Q&A: Depression Is 'Very Treatable')

The impact of Botox on otherwise intractable cases of depression may be surprising, but some researchers (not to mention songwriters and cheerleading coaches) have long believed in the ability of facial expressions to drive our emotions.

That concept is the subject of The Face of Emotion (Macmillan, 2013), a new book by dermatologist and researcher Eric Finzi. The New York Times calls the book "the first authorized biography of botulinum toxin," and it details the various applications of the paralyzing molecule, including, for some people, relief from migraines and the spasticity associated with certain neurological conditions.

But Finzi's most compelling argument focuses on Botox's potency as a depression fighter. It's a modern application of the facial feedback hypothesis, which dates to Darwin, William James and earlier thinkers, and postulates that our facial expressions do not just reflect and convey our emotions; they also create emotions inside of us. We smile when we are happy, but smiling also makes us happy. Similarly, frowning generates negative feelings.

As explained in a Journal of the American Academy of Dermatology essay, "muscular manipulations that result in more positive facial expressions may lead to more positive emotional states in affected individuals." The use of Botox, which reduces our ability to frown by relaxing the corrugator, the frowning muscle between our eyebrows, "might induce positive emotional states." Botox also limits other negative expressions, like brow furrowing. While the treatment does hamper smiles somewhat, it reduces frowns much more. This "net change in facial expression" may have the effect of "reducing the internal experience of negative emotions, thus making patients feel less angry, sad and fearful."


Some researchers believe the effect of Botox on the corrugator may also limit activity in the amygdala, the part of the brain that regulates such emotions as fear and anxiety, leading to greater positive emotions.

Of course, you don't necessarily need to use Botox to generate this effect. You could just smile more. In a study recently published in the journal Psychological Science, University of Kansas researchers asked groups of people to hold chopsticks in their mouths a certain way after performing stress-inducing tasks. The group asked to hold the chopsticks in a way that (unknowingly) formed a smile on their face had a steeper decline in heart rate and a faster physiological stress recovery than the others, co-author Sarah Pressman explained to The Wall Street Journal.

Smiling, Pressman believes, sends a message to the brain that we are safe, which may contribute to greater relaxation, reduced levels of stress and a lower heart rate. Other researchers believe that the type of smile we make enhances the effect, with genuine full smiles, also known as Duchenne smiles, having the greatest impact.

(MORE: Can the Nation Support Boomers' Mental Health Needs?)

In his book, Finzi speculates that we've only begun to grasp the potential impact of Botox and facial feedback on our health. Benching our frowns and negative emotions, he believes, could save marriages and careers. Given the range of theories connecting anger and depression to a range of chronic conditions, Botox may some day be used to ward off heart disease and cancer.

Which would indeed be something to smile about.

Gary Drevitch was senior Web editor for Next Avenue's Caregiving and Health channels. Read More
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