There's been a great deal of hue and cry over the proposed "Botax" that's been running through Congress. That's the street name for a suggested 5% levy on elective cosmetic surgery procedures that would, in theory, raise billions per year to fund expanded healthcare. The great majority of the uproar has come from doctors and consumers of cosmetic medicine concerned that the tax would put such procedures beyond the means of many patients. That's an important issue, but not the objection I have in mind. I want to talk about the possibility that Botox may be an effective treatment for depression.
My interest in this has been building for some time, but it was sparked higher by an experience I had recently after trying my own Botox injection. Not long after I had it, I went to see the new film about the late, great Michael Jackson, This Is It. Now, I grew up on the same street as the Jackson family; I saw some of the early parts of Michael's story play out. So this movie affected me deeply. At the end, I wanted to cry at the tragedy of this brilliantly gifted man's life ending so early. But I couldn't. For some reason, the paralysis of the muscles in my glabellar area due to the injections of botulinum toxin A rendered me totally unable to cry. Curious. But even more surprisingly, when I couldn't cry, I quickly stopped feeling sad. I left the movie with my girlfriend who was feeling very down and I felt so odd that I couldn't find those emotions. I was ready to go to the next activity. Sadness was no where to be found. It was as if the emotion came up, couldn't be expressed, and so, went away. Very curious indeed. Over the next weeks, I had many sad moments and again was unable to cry. The emotions lingered a bit but felt "unreal" and disconnected.
These odd moments, made me wonder about a few things. First, had other women (or men) experienced what I had experienced? Second, could Botox be an adjunctive treatment for depression? It is a great oversimplification to characterize clinical depression as just "feeling sad," but of course overwhelming feelings of sadness or "the blues" are an important component of the disorder and perhaps the Botox may have some role in treating this disabling disorder.
It was tough to find personal accounts to answer the first question so I am tossing the question out to all you blog readers and I am eager to learn from others' experiences. As for the second question, there is preliminary but tantalizing evidence.
It has long been an assumption that there is a link between physical expression of emotions and the intensity of those emotions, otherwise known as the "facial feedback theory." A intriguing pilot study conducted in 2006 by Dermatologist Eric Finzi, M.D., Ph.D. evaluated the effectiveness of Botox in treating depression. In the study, Finzi injected ten women (nine with depression and one with bipolar disorder) with Botox in their glabellar frown lines. After two months, all nine with depression were diagnosed as no longer showing signs of depression. Even the woman with bipolar disorder reported improvements in mood.
That's an amazing result, and if replicated in larger studies, it would be a real boon for those with depression. But how does it work? For years, doctors who administer Botox have reported that many women who receive the injections talk about how much better they feel in general. Is that because looking better makes us feel better? Is it because our faces can't provide negative feedback such as frowning, scowling and crying? Are we more appealing to others when we look happy and this triggers more positive events in our lives? Or is there some neurological pathway being affected by the injections of which we're still unaware? Theories abound. Stanford psychologist Robert Zajonc suggests the effect may be due to the relaxed facial muscles cooling the blood flowing to the brain in a manner similar to relaxation disciplines like yoga and tai chi. UC San Francisco professor emeritus Paul Ekman believes the explanation that expressions stimulate the autonomic and central nervous system is too simplistic. Bottom line, there has been no new research into Botox and clinical depression and no data-driven conclusions about why the mood-alteration occurs or if it is even genuine.
But perhaps it is time for such research if it could aid the millions who suffer with this disabling disorder. That means that our culture must stop trivializing cosmetic medicine, something that the proposed "Botax" does. If we can see treatments like Botox as potentially efficacious treatments for real illnesses instead of luxuries for pampered "real housewives," then we stand a better chance of getting real science behind the anecdotes and real help for patients who need it.