It may raise a few eyebrows, but a new study suggests Botox, the muscle paralyzing wrinkle tonic, may also be a powerful antidepressant.
Researchers who injected Botox into the corrugator and procerus muscles — the pyramid-shaped “frown muscles” between the eyebrows — in people suffering major depression found that, six weeks after a single treatment, more than half (52 per cent) of patients given Botox reported significant and sustained improvements in mood, compared to 15 per cent of patients injected with salt water.
The research is premised on a theory of emotion first proposed by Charles Darwin and William James, the “father” of American psychology, that facial expressions feed information back to the brain and affect how people feel emotionally.
Darwin believed the severely depressed suffered from hyperactive corrugator muscles. He called them the “grief muscles.”
The new study pushes the “facial feedback hypothesis” further. Frowning requires contraction of the corrugator muscles. The researchers thought, why not paralyze these muscles with Botox? Making it harder for people to frown, they reasoned, could reduce distress signals to the brain.
The study, to be published in May in the Journal of Psychiatric Research, was conducted by Maryland dermatologist Dr. Eric Finzi, and Dr. Norman Rosenthal, the renowned psychiatrist who was the first to describe and name “seasonal affective disorder,” or SAD, and the benefits of light therapy 30 years ago.
Major depression is one of the most common and disabling conditions worldwide.
“Honestly, these people suffer. With all that we have at our disposal nowadays, they continue to suffer,” said Rosenthal, a clinical professor of psychiatry at Georgetown University Medical School in Washington, D.C.
Antidepressants are only partially effective, and, when they do work, the side effects such as decreased libido and insomnia can be “deal breakers,” Rosenthal said.
The beauty of Botox, he said, is that it doesn’t enter the bloodstream and interact “with all the other chemicals you’ve already added.”
Botox, which is derived from the Clostridium botulinum bacterium, the toxin that causes botulism, works by blocking the release of a substance called acetylcholine that sends signals from the brain telling the muscles to contract.
As a result, muscles go slack, flattening the skin and reducing wrinkles, lines and furrows.
But doctors have been using the wrinkle agent for an ever-widening array of ailments, including migraine and tension headaches, chronic low back pain and muscle spasms in adult stroke patients.
The new depression study included 74 adults aged 18 to 65 with major depressive disorder. Less than half were on antidepressants at the time.
Participants were randomized to receive either Botox or saline injections into five injection points into the corrugator and procerus muscles between the eyebrows.
Six weeks after the injections, the Botox treated group showed a “decreased ability to form an effortful frown,” the researchers report.
What’s more, their depressive symptoms decreased by 47 per cent, compared to 21 per cent in the saline group.
The remission rate was also significantly higher in the Botox treated group (27 per cent) compared to placebo (seven per cent).
About half the patients in the Botox group were able to correctly guess which treatment they received. However, Rosenthal said there were no differences in changes in depressive symptoms between those who guessed their treatment correctly, and those who did not.
The study lasted just six weeks, and most of the participants were women. However, Rosenthal says one of his “very best” responders is a man. “I have no reason to believe they (men) would be any less responsive.”
It’s not clear how Botox may help ease depression. However, there are several possible mechanisms, they said.
According to Finzi and Rosenthal, “frowning may affect the way people feel about themselves when they look in the mirror and the way others respond to them.” “Happier” facial expressions may lead to “more positive social interactions,” they added.
They also believe the brain continuously monitors facial expressions, “and that the mood responds accordingly.” Freezing the frown muscles with Botox may interrupt that circuitry.
But there are important limitations.
“Botox wears off, it’s costly and it doesn’t work for everybody,” Rosenthal said. An average treatment costs about $400 US and lasts two to three months.
However, “Depression is a hugely common illness,” Rosenthal said.
“We’re just grateful for anything that could chisel off another 10 or 15 per cent of the problem.”