Botox as a Treatment for Depression?

One in 10 American adults struggle with significant depression during their lives, and women are twice as susceptible as men of the same age. Can Botox help provide relief? Converging lines of evidence suggest a role for facial expressions in depression and its treatment.

When it comes to beating depression, beauty products usually don’t do the trick. Enter Botox, the forehead-smoothing toxin that can erase fine lines, stop sweating, and even squelch migraines. It turns out that Botox may have the power to make you happier—and not just because your wrinkles have disappeared.

In the largest study to date on the effect Botox on depression, researchers Eric Finzi, MD, PhD, and Norman E. Rosenthal, MD, found that 52% of subjects suffering from moderate to severe depression showed relief from depression after injection of Botox to the glabellar area between the eyes, compared with only 15% of those who received the saline placebo. The study, “Treatment of depression with onabotulinumtoxinA: A randomized, double-blind, placebo controlled trial” is published in Journal of Psychiatric Research, Volume 52 (May 2014). These findings help to confirm a novel concept for mental health – using facial expressions to influence thoughts and feelings. Two other studies show similar results that Botox can help with depression, one of which was a topic at the 2014 American Psychiatric Association Meeting.

Amazingly, a single treatment with Botox appears to induce a significant and sustained antidepressant effect in 52% of participants with major depression. Responders experienced better than 50 percent reductions (including remissions) in their depression symptoms after a single Botox injection.

The thought that facial expression don’t just communicate emotions we’re feeling, but intensify our experience of them by sending cues back to the brain is not new. Charles Darwin came up with that the “facial feedback theory,” almost 150 years ago. Simply put, physical expression is an integral part of emotion. You can feel sad or angry without moving your face, but, the theory holds, those emotions will not be as strong or persist for as long if your face is not moving in the expected manner.

How does the treatment work?

Botox, which is made from the botulinum toxin, is administered by injecting minuscule amounts of it into the facial muscles. The same muscle in the forehead is involved in the expression of sadness and anger and fear. Botox is an inhibitor of nerve transmission, so the muscle can’t contract.

This new treatment holds promise as a supplement or alternative to anti-depressants and psychotherapy for treating depression. The treatment isn’t perfect and it’s not a sure thing. Botox is expensive, at up to $400 per treatment, wears off in about three months and isn’t covered by insurance for this purpose. As the studies show, it doesn’t work for everyone. But the botulinum toxin already an approved intervention to treat a wide variety of medical conditions. Perhaps depression is next.

Early naysayers scoffed, saying that Botox was an act of vanity and that people felt better about themselves because they looked in the mirror and thought they looked younger. Growing evidence challenges this as too simple an anwer.

There are current Phase II clinical trials in process for Botox being used in treating major depressive disorder in women. Some researchers believe that Botox will become a “standard treatment for depression in the future.”

We must take care to avoid oversimplifying depression. Depression is a complex and serious illness that, while very treatable, is difficult for some people to resolve, resulting in severe suffering. Depression has always been something that’s best treated by a range of things, individualized to each person. Cookie cutter treatment isn’t the answer. But Botox may be a new tool that’s helpful to many.

According to Dr. Mark Tuccillo at the Petersburg Medical Center, the cost for cosmetic treatment with Botox is based on how much Botox is used, the range usually being between $280 and $400. Dr. Tuccillo has received specialized training in the use of Botox and other cosmetic treatments. For more information contact the Petersburg Physicians Clinic at 907-772-4299.

Written by Susan Ohmer, LCSW and brought to you by PMHS and WAVE, with funding from the Trauma Project Grant from the Division of Behavioral Health.

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