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The Wrinkly Science of Using Botox to Treat Depression

It may sound too good to be true, but studies show that not being able to frown might actually make you feel happier

Many people who get Botox seem pleased with their results — not that we could necessarily tell from their facial expressions. But according to a growing body of research, these seemingly superficial injections may have much deeper implications when it comes to treating depression, too. 

Admittedly, that sounds like a bunch of Big Pharma bullshit meant to push Botox and explain how the Real Housewives can sleep at night. It especially seems like a stretch to add another perk after claims that Botox can cure everything from excessive sweating to chronic migraines. But as the pandemic goes on indefinitely and people continue to isolate among joblessness and economic despair, about 40 percent of adults in the U.S. now report having either a mental health or substance abuse problem, up from 20 percent in 2017. Consequently, therapists aren’t about to knock something that has helped some people — and could help more — simply because it seems too convenient. 

“The research on utilizing Botox to aid in the treatment of major depression is promising,” explains clinical psychologist Carla Manly. “Although the studies to date are relatively small and short-term, the results indicate that depression sufferers find additional relief from it.” 

The data Manly references began with a 2006 study of just 10 people who had depressive symptoms that were resistant to drug and therapeutic interventions. After receiving injections of botulinum toxin A to their glabellar frown lines, nine of them reported they were no longer depressed eight weeks later, and the 10th cited improvements in their mood. The topic wasn’t broached again until 2012, this time with 30 people. After six weeks, participants who received a single Botox injection reported a 47.1 percent reduction in depressive symptoms, compared to only a 9.3 percent reduction in the control group. 

Similar trials with comparable results followed in 2013, 2014 and 2017. All but one, though, had fewer than 30 participants. In the largest and most recent study published in July, scientists analyzed 40,000 reports from the FDA and found that people who had some form of Botox across six different sites for wrinkles, sweat reduction, migraines or muscle spasms felt depressed 40 to 88 percent less often than patients who didn’t get Botox for the same conditions.

This makes sense from evolutionary and psychological perspectives given that humans are often unconsciously driven by the effects of their emotions,” Manly says. 

Essentially, in the same way that smiling even when you’re not happy can boost your mood, frowning for any reason can have the opposite effect. “When a person frowns, the brain registers the negative emotion, and the frown deepens or persists. When the frown is inhibited, via Botox or other means, the brain will register less of the depression-inducing emotion,” Manly continues. 

That said, not everyone is convinced that Botox will do much for the average person’s mental health — specifically plastic surgeons, who surprisingly aren’t pushing Botox for depression. “Botox doesn’t treat depression, but it’s clinically proven to treat conditions such as migraines that people with depression are often prone to experience,” explains Javad Sajan, a Seattle-based plastic surgeon. 

To that point, Sajan suspects we have it backwards: Botox doesn’t treat depression exactly, but it can quell some of the symptoms, like low self-esteem. “Botox can affect a person’s self-perception and treat feelings of self-consciousness. Not only can this improve one’s self-esteem, it can also change others’ perception of you by removing an angry look from your face,” Sajan argues. “This can lead to more positive interactions with people, which can boost the mood and alleviate some feelings and symptoms of depression.”

An improved appearance may not guarantee a good mood, but it can certainly help. There’s evidence that attractive people are generally seen as more competent, trustworthy and treated better overall. Still, a review of past studies on Botox and depression indicated that the level of line reduction didn’t influence depression reduction, suggesting that no matter how much or little Botox did to improve a person’s appearance, the impact on depression was consistent either way. 

If one of Manly’s clients were to come into her office claiming that Botox helped with their depression, she would be supportive — because they’re showing up to therapy as well. Her main concern is people who might be depending on Botox alone to treat their depression, without talking to a therapist or trying medication as well. But for individuals who aren’t experiencing enough relief from traditional forms of depression treatment alone — and have the financial means to try something with a vanity bonus — Botox may not be the worst idea. 

“Using Botox in this manner wouldn’t replace other treatments such as psychotherapy and medication, but it could offer additional support to those who suffer from more intractable depression,” Manly tells me. 

It’s like the old adage goes — if you can’t turn that frown upside down, get rid of it altogether.

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