Botox injections may ease depression symptoms

WASHINGTON – Kathleen Delano had suffered from depression for years. Having tried psychotherapy and a number of anti-depressant drugs in vain, she resigned herself to a life of suffering.

Then she tried Botox, the drug that became a rage a few years ago for smoothing facial wrinkles.

In 2004, her physician injected five shots of the toxin into the muscles between Delano’s eyebrows so the Glenn Dale, Md., woman could no longer wrinkle her brow. Eight weeks later, according to an unusual study published this month, her depression had lifted.

“I didn’t wake up the next morning and say, ‘Hallelujah, I am well, I am healed,’ ” she said in an interview, but she noticed changes. “I found myself able to do the things I hadn’t been doing. I feel I broke out of the shackles of depression to be in the mood to go out, to reconnect with people.”

The pilot study of 10 patients is the first to provide empirical support for what a number of clinicians say they have noticed anecdotally: People who get their furrowed brows eliminated with Botox (botulinum toxin A) often report an improvement in mood.

Until now, the assumption was that they were just feeling better about their appearance. But the new study by dermatologist Eric Finzi suggests something else might be at work. Finzi found that even patients such as Delano, who were not seeking cosmetic improvement, showed a dramatic decrease in depression symptoms.

“Maybe the frown is not just an end result of the depression; maybe you need to frown in order to be depressed,” Finzi said in an interview. “I don’t think it has anything to do with making you look better. These patients were not coming to me for Botox; they were coming because I was offering a new treatment for depression.”

Some patients in Finzi’s study were receiving other treatments for depression; Finzi required that there be no change in those treatments for three months before he injected the Botox.

Finzi agreed the effects of Botox on depression must be investigated in a much larger study before conclusions about a link can be established, but a growing body of work suggests that changing expressions can influence mood. People asked to smile while watching a cartoon, for instance, report it is funnier than people who are not asked to smile.

Alastair Carruthers, president-elect of the American Society for Dermatologic Surgery, agreed Finzi’s study provides new insight into a phenomenon clinicians have noticed.

“Anyone who has injected much Botox into the frown area has had people come in and say they can’t believe how they feel better as a result,” said Carruthers, clinical professor in dermatology at the University of British Columbia in Vancouver. “We’ve not really been able to put our fingers on why.”

Finzi’s study was published this month in the society’s journal, Dermatologic Surgery.

Of the 10 depressed patients in the Washington area whom Finzi studied, nine recovered from their depressive symptoms, and one – who turned out to have bipolar disorder, or manic depression – showed an improvement in mood.

Delano, now 45, a marketing director, said that by the time she got involved in the study, she had turned down so many invitations for social gatherings that people had stopped asking her. She went to see Finzi, who practices dermatology in Maryland, for a transient skin problem, which is when she heard he was recruiting patients for a novel treatment study of depression. He gave her two rounds of Botox injections.

“After a couple of days, the muscles in your forehead, you can’t constrict them,” she said. “You don’t have that anxiety look. You can’t furrow your brow … (but) for me there was not a dramatic cosmetic difference.”

But where once she would hide out at home in the evenings and on weekends, Delano said, she found herself enthusiastically cheering her 8-year-old son at sports games. Her relationship with her boyfriend improved, she said.

“My theory on why this works is there is a feedback between the muscles of facial expression and the brain,” said Finzi, who has applied for a patent on using Botox for depression.

The theory is similar to one proposed by Robert Zajonc, a psychologist at Stanford University, who thinks facial muscles might alter the temperature of blood flowing in the brain. Relaxation techniques such as yoga and tai chi might help cool the brain and result in a more positive mood, Zajonc said.

Whatever the mechanism, moods can clearly be influenced by expressions, said Paul Ekman, emeritus professor of psychology at the University of California at San Francisco, who has spent decades exploring the connection between emotions and expressions.

But Ekman said it is unlikely that simply altering one’s expressions can relieve depression.

More plausible, Ekman said, is that changing expressions can help heighten or decrease emotional states. Or it is possible that by frowning less, patients in Finzi’s study seemed less forbidding to others, which helped to strengthen their social connections. In turn, that may have helped ease the depression, Ekman said.