Can botox really improve depression?

Well some people do seem to think so & there are a few mechanisms by which Botox is thought to help with depression. Important here is that it MAY help & is NOT a substitute for appropriate assessment & treatment by a psychiatrist!

Proposed mechanism of improvement in depression.

One of the main mechanisms proposed is through emotional proprioception or the facial feedback hypothesis. It is well understood that the muscles of facial expression play an important role in expressing our mood but their action also transmits information to the brain’s emotional circuitry. Movement of these muscles therefore has an influence over reflecting but also influencing our mood.

Muscles in our forehead are largely involved in the expression of negative emotions. Relaxing glabellar muscles by means of BoNt injections may not only give the face a less negative/more positive expression but may also interrupt the described feedback loop and thereby confer a less negative/more positive emotional state.

Several conditions that are treated with BoNT, such as chronic migraine, torticollis, blepharospasm, or hyperhidrosis, are associated with high prevalence rates of comorbid depression. BoNT treatment is not only effective in the primary indications but may also alleviate the symptoms of concomitant depression.

A number of trials and meta-analyses have shown the benefit of BoNT in the treatment of depression. It is considered by many to be a useful adjunct to traditional therapy due to it’s ease of administration and its favourable side effect profile. Given how common depression is and how debilitating it is to those affected, new approaches to treatment are needed and provide potential options to alleviate symptoms.

Finzi E & Rosenthal NE Emotional proprioception: Treatment of depression with afferent facial feedback. J Psychiatr Res. 2016 Sep;80:93-96. doi: 10.1016/j.jpsychires.2016.06.009. Epub 2016 Jun 16 Wollmer MA et al Treatment of Depression with Botulinum Toxin. Toxins (Basel). 2022 Jun; 14(6): 383. Published online 2022 May 31. doi: 10.3390/toxins14060383