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"Exploring the Connection: Can Botox Really Impact Mood and Depression?"

Updated: Apr 10

The benefits of Botox and finally removing the stigma of getting it. The amount of Botox injections given has increased by nearly 459% since 2000.

botox, c2 aesthetics, depression
Benefits of Botox that Impacts Mood

What is Botox?

Botulinum toxin is a potent neurotoxin, meaning it damages or impairs the functioning of the nerves.

Produced by several bacteria (mainly Clostridium botulinum), botulinum toxin is responsible for a rare but sometimes deadly disease called botulism (e.g., foodborne botulism). Foodborne botulism, of course, is usually associated with improperly canned food.

The mechanisms of botulinum toxin’s actions are complex. Put simply, they involve preventing the release of the neurotransmitter acetylcholine at the neuromuscular junction, where muscle cells and motor neurons meet. The action of the toxin can have dangerous consequences, especially when it results in blocking the transmission of messages between nerves and important muscles, such as those that help us breathe.

But what if we injected a small amount of the toxin into the muscles responsible for, say, frown lines? Indeed, many people are aware of the uses of this toxin for cosmetic purposes (as OnabotulinumtoxinA injections, known as Botox), such as for relaxing and softening the muscles that cause facial wrinkles. What some people may not know is that Botox injections are also used for the management of other conditions including hyperhidrosis (excessive sweating), migraine headaches, urinary incontinence, certain eye conditions (e.g., lazy eye, eye twitching, crossed eyes), as well as other types of excessive muscle contraction and stiffness (e.g., cervical dystonia, which is a painful type of neck spasm).

How does Botox influence mood and depressive symptoms?

A newer use of Botox injections has been in the treatment of depression. Yes, depression.

For instance, the results of a randomized, placebo-controlled trial, published in 2014, showed that Botox injections into facial muscles (the corrugator and procerus muscles) reduced depressive symptoms. The response rate (50% or greater reduction in Montgomery-Asberg Depression Rating Scale scores), measured six weeks after the injections, was 15% in the placebo injections group but 52% in the Botox injection group.

So, how might Botox injections reduce depression? One explanation, called the facial feedback hypothesis, involves how changes in facial expressions affect the brain.

For example, when we frown, we are more likely to evaluate unpleasant stimuli (e.g., a picture of a couple arguing) more negatively than usual. Indeed, contracting facial muscles (e.g., muscles used for the emotional expression of rage or pain) can affect the autonomic nervous system activity, resulting in changes in sweating, blood pressure, heart rate, etc. Botox injections might interfere with these effects. How? By signaling to trigeminal nerve endings in the face—nerves potentially involved in sensing muscle tension and pain—“a relief of physical stress, resulting in decreased emotional stress.” In short, Botox injections break up the feedback loop from certain facial muscles—muscles communicating to the brain that one is feeling angry, sad, miserable, etc. Note that other mechanisms for the positive effects of Botox on depression have also been suggested. These consist, among others, of the effects of Botox on the central nervous system via various direct and indirect pathways, more positive self-awareness (greater self-confidence and satisfaction due to improved appearance), and altered social interactions (e.g., those appearing more relaxed and happy being more approachable).

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