Botox Isn’t Just For Wrinkles — It Could Also Help Fight Depression 

When I hear the word “Botox,” my brain can’t help but think of Jennifer Coolidge in A Cinderella Story, saying: “It's the Botox! I can't show emotion for another hour and a half.” It turns out that Botox may do much more than temporarily impact our ability to show emotions — it might actually affect how we feel them, too. New research finds that Botox might ease depression after being injected in various parts of the body, according to a 2020 article in the journal Scientific Reports. 

The science builds on the existing body of research into whether the drug — which is made from a toxin that the bacterium Clostridium botulinum produces — can shift our moods. For at least the last 15 years, studies have been trying to put a finger on how, exactly, treatment with Botox might work as an antidepressant. This new article calls into question a hypothesis researchers focused on in the past: that the drug might cut off a feedback loop between facial expressions and negative emotions. Based on this theory, previous studies mainly injected the forehead to target the skin between the eyebrows and above the nose where our “grief muscles” are, the article notes. But these results were limited and inconclusive. 

Although the Scientific Reports study says this theory is “plausible,” its findings indicate that the roots of Botox’s potential depression-fighting effects are more complicated. 

The Scientific Reports article analysed more than 45,000 clinical reports of adverse events resulting from Botox that was injected  — not only for cosmetic use — but also to help treat issues such as migraines, excessive sweating, neck pain, excessive drooling, involuntary blinking, limb spasms, or spasticity, and for bladder disorders. The data was pulled from the U.S. Food and Drug Administration's Adverse Event Reporting System. 

Researchers separated patients into eight individual groups based on which medical condition they turned to the drug for. Patients in each of these eight categories were divided into subgroups: one who received Botox and one who did not.

Researchers were then able to determine that patients who received the injections to address facial wrinkles, excessive sweating, migraine, spasms, and spasticity reported depression 40% to 88% less often then the folks who underwent treatment other than Botox for the exact same conditions. 

"We found that [the effect] doesn't depend on the location of the injection and it doesn't depend on the [medical conditions], which are quite diverse for Botox," Ruben Abagyan, the study’s lead author and a professor at the University of California, San Diego, told CNN. "The implications of that are fascinating because it means that depression can be cured with different (means) and not necessarily by injection in one of the facial muscles, which may be unwanted in some cases." 

There are a few possibilities to be explored in future studies as to how Botox works to fight depression. One theory is that Botox affects the central nervous system and the way it regulates our emotions. Traces of Botox may get into our bloodstream, and then get to the brain, Abagyan, proposed to CNN. It also may have to do with muscle tension. 

There were some limitations to the study, including the fact that the sample groups they use were based on an FDA reporting system that is voluntary. The researchers also had limited details on demographics, medical records, and what medications and supplements patients were on, though they removed patients who were taking antidepressants so the study results wouldn’t be biased.

It’s also fair to wonder if some of the chronic conditions managed with Botox caused secondary effects on mood. For example, if excessive sweating was stopped by Botox, it might have improved the emotional state of the patients. "This study makes me wonder if having muscle spasms or sweating may be giving us a physical feeling of depression as well, and by treating this 'sensation of depression' we can affect not just a patient's medical problem (but) their psychological wellbeing as well," as Jason Reichenberg, MD, a dermatologist at Ascension Medical Group and an associate professor of internal medicine at the University of Texas at Austin, told CNN. 

Although more research needs to be done before determining how and whether Botox can be an effective remedy for depression, it could be a fair alternative for those who haven’t successfully treated their symptoms via typical methods such as FDA-approved antidepressants or therapy, researchers say. This is a fair amount of folks — the article notes that common depression treatments aren’t considered effective for almost one third of the more than 264 million people around the globe who suffer from depression. If Botox can help, it would be groundbreaking. Should research find it doesn’t have serious side effects, there could be a future where psychiatrists are handing out Botox prescriptions.