Jordan Gaines Lewis, Ph.D.

Brain Babble

Paralyze Your Face, Fight Depression

How side-effects of Botox may help those with treatment-resistant depression

Posted Aug 13, 2012

I'm willing to bet you've taken note of the expression-less faces on heavily-Botoxed people.

With their vanished crow's feet, missing smile lines, lack of forehead wrinkles, and paralyzed cheeks, eventually we just can't tell whether Botox abusers are happy, sad, angry, worried, scared...

As it turns out, however, this side effect may actually be a good thing for individuals with depression who are resistant to other forms of treatment.

Botox is the trade name for botulinum toxin, a powerful neurotoxin which, in very small medical doses, functions to paralyze the muscles of the face (or wherever it's injected). On the other hand, severe botulism poisoning, which occurs primarily through food contamination, can result in paralysis of respiratory muscles, leading to respiratory arrest, coma, or death if untreated.

Botox functions by blocking the neurotransmitter acetylcholine from being released by the axon terminal of a neuron. Typically, acetylcholine binds to receptors on muscle, causing contraction; inhibiting this results in paralysis.

Neurochemistry of botulinum toxin.

In the 1890s, psychologist William James promoted his facial feedback hypothesis. James believed there was a link between physical facial expressions and emotional states. Indeed, a number of studies in the 1980s and '90s support this notion.

In the May issue of the Journal of Psychiatric Research, researchers M. Axel Wollmer and colleagues at the University of Basel in Switzerland reported that paralyzing the glabellar frown region—the area between the eyebrows—with Botox significantly improved symptoms in depressed individuals.

The study included 30 participants, each of which had major depression and were unresponsive to traditional antidepressive medications. Fifteen individuals were assigned to receive a dose (five injections) of Botox, while the other fifteen received placebo (saline) injections.

Six weeks after this single dose, individuals were assessed for depressive symptoms using the 17-item Hamilton Depression Rating Score. Researchers found that those who received Botox injections experienced a 47% decrease in depressive symptoms, compared to just 9% in the placebo group. This improvement remained over the 16-week study period.

This was the first randomized, controlled study on the effect of Botox on depression.

As James proposed 120 years ago, we now have more evidence that facial muscles are not only critical in communicating emotion to others, but also for an individual to experience emotion for themselves.

So the next time you pull a "Marcia Brady" and feel compelled to hold a crying vigil in front of the mirror, just try to crack a smile. Braces may not keep your spaghetti from tasting like lead, but the shiny grin may at least boost your mood.

Wollmer MA, de Boer C, Kalak N, Beck J, Götz T, Schmidt T, Hodzic M, Bayer U, Kollmann T, Kollewe K, Sönmez D, Duntsch K, Haug MD, Schedlowski M, Hatzinger M, Dressler D, Brand S, Holsboer-Trachsler E, & Kruger TH (2012). Facing depression with botulinum toxin: a randomized controlled trial. Journal of psychiatric research, 46 (5), 574-81 PMID: 22364892

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