Botox for Depression?!?

In Short, Yes… maybe.

Glabellar Botox (between the eyebrows – the scowl muscles)  has been hypothesized to disrupt proprioceptive feedback (facial sensation) reinforcing negative emotions which may help depression. (You don’t feel you’re scowling so you’re less depressed I suppose). But there is more to it than that.  Post marketing surveillance of Botox data indicate that patients who received Botox injections to treat hyperhidrosis, facial wrinkles, migraine prophylaxis, spasticity, and spasms, had a significantly lower number of depression reports when compared to patients undergoing different treatments for the same conditions. These findings suggest that the antidepressant effect of Botox is significant, and, surprisingly, is observed over a broad range of injection sites.

Doc, tell me more!

Omega melancholicum – see explanation in the post script below

Interestingly, the antidepressant effect of Botox did not depend on the injection site. Which means the whole facial proprioception disruption theory isn’t the whole story. There are some theories, but nobody knows for sure why Botox improves depression. The interesting thing is that doses used for upper and lower limb spasticity are huge compared to the minute amount used in blepharospasm, but the effect on depression is about the same.

Most of the evidence on the antidepressant effect of Botox comes from studies of glabellar injections (the scowl or 11 lines) and in migraine treatment. There are upcoming phase III trials looking at Botox as a treatment of depression.

The Need for New Treatments for Depression

Three hundred million people worldwide suffer the physical and mental pain of depression. According to the World Health Organization (WHO), depression is the leading cause of disability worldwide. And because a large portion of people do not respond completely to our current therapies, millions of people suffer chronic depression.

In other words, we need something that works better than our current therapies.

Recently, a review article, which covered the past two decades, showed that even though serotonin reuptake inhibitors improve the symptoms of depression for millions of people, they also increased the risk of suicide, and (surprisingly) the article also showed that the whole idea of a “chemical imbalance” of serotonin in the brain causing depression is wrong. (Moncrieff2022) (Wise2022)

I am not saying we should throw away all antidepressants, but we need to get off the idea that we have depression all figured out and we don’t need something better to treat it; because we do.

Also, as an internist, I would never propose a magic bullet. Depression can also be caused by situations, life events, hypothyroidism, low testosterone or growth hormone levels, malnutrition, postpartum hormone changes, elevated prolactin from pituitary microadenomas, and much more; Botox would not help any of these.

So, Botox is not a magic bullet to cure all depression. But multiple papers and strong science do suggest that Botox can be used for depression as part of a multifactorial approach in some people.

My Request

If you think you would like to try Botox to help with your depression, DO NOT STOP TAKING ANY ANTIDEPRESSANTS YOU MAY BE TAKING; you can take your antidepressants and still use Botox to help them work better. Or, if you suffer a milder depression or anxiety (and you’re not on medications and not contemplating suicide) and want to see if Botox might help you feel better, then that is also good. In either case, call Rejeune MD at (262) 373-0169 to schedule your no obligation Botox evaluation.

p.s. – Darwin’s contribution to psychiatry

Just a note about the picture in this post. Darwin’s actual contribution to psychiatric learning appears not in Origin of Species but in his often overlooked work, The Expression of the Emotions in Man and Animals, published in 1872. There he described what subsequently was called omega melancholicum or ‘the omega sign’, a facial expression involving a wrinkling of the skin above the nose and between the eyebrows that resembles the Greek letter omega. It seems to be diagnostic of melancholic illness.