Steven Lippmann, M.D.  

“Botox”, or botulinum toxin, has long had popular cosmetic use at smoothing facial wrinkles.  It is also prescribed for pathologies, mostly of neuromuscular origins, like in pain syndromes and/or muscular spam cases. Many people like and benefit from the results.

Researchers began noticing that injecting extracts from the bacterium Clostridium botulinum into the glabella muscles seemed to improve mood. They wondered if facial injections into these tissues might even attenuate affective disorders. After observing the positive emotional outlook among some individuals receiving glabellar botox for a variety of medical indications, investigators focused on psychiatrically assessing whether botox is an independent mood elevator.

Fewer wrinkles may improve self-concept and that might elevate spirits. The new contention additionally suggests that facial botox shots induce neurochemical influences that physiologically mitigate depressive illnesses. They might even help people gain a more positive mental outlook despite treatment-resistant depressions.

This neurotoxin inhibits acetylcholine release at the neuromuscular junction and temporarily paralyzes affected muscles. Perhaps paralysis of glabellar musculature provides central nervous system feedback to attenuate excessive cholinergic stimulation during a depression. Maybe it works like the feedback mechanism of vagal nerve stimulation and/or other similar means of indirectly-yet-centrally affecting brain function. There is no known contraindication to giving botox injections while co-prescribing antidepressant drugs, psychotherapy, or other interventions. Details are unknown, but botox injections remain interesting and are worthy of consideration as a means of helping selected patients with mood disorders.

Suggested readings

1. Coles NA, Larsen JT. Kuribayash J, Kuelz A. (2019). Does Blocking Facial Feedback Via Botulinum Toxin Injections Decrease Depression? A Critical Review and Meta-Analysis. Emotion Review, 11(4), 294–309. https://doi.org/10.1177/1754073919868762. Accessed in May 2022.
2. Finzi E, Wasserman E. (2006). Treatment of Depression with Botulinum Toxin A: A Case Series. Dermatologic Surgery, 32(5), 645–650. https://doi.org/10.1111/j.1524-4725.2006.32136.x. Accessed in May 2022.
3. Qian H, Shao F, Lenahan C., et al. (2020). Efficacy and Safety of Botulinum Toxin vs. Placebo in Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in Psychiatry, 11, 603087. https://doi.org/10.3389/fpsyt.2020.603087. Accessed in May 2022.
4. Risch SC, Cohen RM, Janowsky D S, et al. (1980). Mood and behavioral effects of physostigmine on humans are accompanied by elevations in plasma beta-endorphin and cortisol. Science (New York, N.Y.), 209(4464), 1545–1546. https://doi.org/10.1126/science.7433977. Accessed in May 2022.