Botox fights Depression?

Mark Dombeck, Ph.D. was Director of Mental Help Net from 1999 to 2011. Dr. Dombeck received his Ph.D. in Clinical Psychology in 1995 ...Read More

Yesterday, while glancing at the television (Good Morning America) I saw that clever marketing people have now positioned botox (the injectable toxin that relaxes/paralyzes muscles in the face, resulting in fewer visible facial lines) as a new cure for depression. I haven’t seen the actual press release that this information is based on yet, but I feel a need to chime in ASAP by saying that this announcement seems suspicious to me, but also reasonable at the same time. I’ll explain:

I’m not shocked that there could be some relationship between facial paralysis and a lessening of emotionality. It has been known for years that there is a relationship between the amount of passion and intensity of emotion that someone can experience and paralysis. People who become paralyzed supposedly do experience a lessening of intensity of emotion. I’ve not experienced this myself, so can’t claim it first hand, but I have read of this somewhere years ago. If I’m pressed to explain why this effect might occur, I’d invoke the idea of feedback. The word "motion" is not embedded inside the idea of emotion for nothing. Physical expression of the body and the face is a vital part of what it means to be emotional. When you are emotional, your body moves, and the feedback from this movement is communicated back to your brain, amplifying the experience of the emotion. If you are angry, you tend to wave your hands up and down and clench your fist. If you are sad, you tend to frown and cry and wring your hands. The more you make these emotion-linked movements, the more your experience of the particular emotion is solidified.

botox treatments reduce facial wrinkling by paralyzing the facial muscles. This would naturally reduce a person’s capability of producing facial emotion behavior, and such a reduction of facial emotion might conceivably block any amplifying capacity that facial expressions might have, resulting in a deadening of the expressed emotion. "Might" is the key word here. I don’t know this for fact – I’m making this explanation up based on the stuff I’ve read before.

There is a big distance between this sort of paralysis-mediated emotional blocking, and a reasonable depression treatment however. Depression, particularly when it is severe and chronic, is an intense and brutal illness which colors all aspects of life, and which can be lethal when left untreated (e.g., the risk of suicide is real). It is not at all clear that blocking the facial musculature messages going back to the brain will ever be a sufficient treatment for serious depression (although it might be a good adjunctive treatment, possibly, if this effect is replicated).

Even if botox facial injections were shown to be a good treatment for reducing depression symptoms, the best they can offer someone is to reduce the amount of depression someone might be experiencing. This is not the same thing as increasing the amount of joy they can experience. If botox fights depression, it probably also fights joy, I’m thinking. Both emotions produce characteristic facial expressions, and botox would block both from occurring, thus blocking any sort of emotional amplifying effect on emotional state that facial expressions might have. The overall effect would be something more akin to a sort of neutral emotional flatness than anything else. Not exactly a good effect to hold out to the majority of non-depressed people who use botox as a cosmetic enhancement procedure. I can just imagine the product labeling warning stickers: "Warning: botox suppresses intense emotions of any sort. Not safe to use before your daughter’s wedding or other happy occasions".

There are other problems as well. Maybe the feedback explanation I’ve given above is wrong. Maybe people who use botox feel less depressed, show fewer depression symptoms after using botox because they were depressed about their appearance, and using the stuff reduced their wrinkles, making them feel better. Maybe the simple action of going for a cosmetic procedure made them feel more in control of their lives, and this helped them to feel less depressed. There is a whole lot of careful work that will have to occur to tease apart the real causes behind this odd anti-depression effect that botox seems to have before it will be reasonable to use it for an antidepressant purpose.

Nevertheless, if this effect is real – if it can be replicated that botox will dampen the intensity of depression, then this is a truly fascinating and useful finding; One of those serendipitous effects that you end up uncovering by mistake and it changes everything.