Botox for depression? Are you crazy?

By Dr Sarah Hart

Cosmetic doctor Sarah Hart argues that Botox treatment could actually improve your mood, on MiNDFOOD.

I trained as both a cosmetic doctor and a psychiatrist and have treated people for depression with medication and therapy. The process was fairly slow and difficult, dealing with the unwanted side effects of medication or reluctance to attend therapy.

But in my job as a Botox doctor, people were thrilled with what I did after just one week. “I feel the best I have in years!” they’d say, faces beaming. “I feel like I’ve got a new lease on life.” This was usually after erasing the frown lines that creased vertically between their brows. I really started to wonder: Was Botox having an effect on my cosmetic patients’ moods as well as treating their wrinkles? Did looking happier make them feel happier?

It turns out there is a study that has looked into that very question. And the answer is yes, Botox can improve your mood.

The study, titled Treatment of Depression (which appeared in the journal Dermatologic Surgery in May 2006) involved 10 people who fit the criteria for clinical depression and had not responded to antidepressant medication. Their frowning muscles were treated with Botox. It makes sense to treat this area. My psychiatric training taught me to check for a typical facial expression in depressed people, which was “contraction of the corrugator and depressor muscles between the brows”. This physical expression of distress and worry goes hand-in-hand with the disease of clinical depression. And these are the same muscles you relax with a Botox treatment for frown lines.

The study results were remarkably good. Nine of the 10 patients no longer scored as clinically depressed when they were retested two months after treatment. One patient’s depressive symptoms returned when the Botox wore off, only to disappear again after a second treatment. 

So how can a medication that affects only the muscles of the face have an impact on mood? You might assume the typical facial expression of depression is a result of feeling depressed. But it goes both ways. Actors report that imitating the facial expressions of negative emotions can cause them to feel that emotion.

Charles Darwin wrote: “The free expression, by outward signs, of an emotion intensifies it. On the other hand repression, as far as this is possible, of all outward signs softens our emotions.”

In this “facial feedback hypothesis” there is a backwards link between the expressions we make and the mood we feel. Ask a depressed person to make happy expressions and their mood lifts a little. So with Botox, if you prevent the face from frowning you can lift the spirits. And it works unexpectedly well.

As yet, Botox is not an accepted treatment for depression. One small study is hardly good evidence. I believe it could be a useful adjunct in some cases, but not a replacement for good mental healthcare. But there are few downsides to trying, beyond the cost. I’ve not experienced clinical depression but I know I feel more relaxed and mellow when I can’t frown. But it might take a while – and some more studies – before medical insurers can be persuaded to pay out for Botox treatments to treat mental health.


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