Forget My Wrinkles: I Have Botox for Depression!
Updated: Jan 6, 2019
Last week I had a patient divulge to me that she wasn't too bothered about her wrinkles. She was having botox for her depression. This isn't the first time I've met such a client so I decided to do a bit of investigating into this latest use of the wonder drug.
This journey takes us all the way back to the father of evolution: Charles Darwin. Darwin proposed that facial expressions feed information back to the brain. In simpler terms, when we feel unhappy we frown, but frowning can also make us feel unhappy. More recent research also supports this as the frown muscles are active when we experience fear, sadness or anger. In fact, people who suffer from depression have been shown to have greater activity in their frown muscles than those who don't. Darwin even went as far as to call these muscles, the muscles of grief.
Two US based doctors, Dr Normal Rosenthal, a psychiatrist and Dr Eric Finzi, a dermatologist decided to test this " facial feedback hypothesis" using the popular anti-wrinkle treatment: Botox. Botox works by binding to the muscle receptors, preventing the muscle from being activated. As the muscle is weakened it is less able to move. This reduces the appearance of wrinkles, especially in the frown area of the face. These scientists proposed that by injecting botox into the frown muscles, the muscles would not be able to transmit signals to the brain. Signals that normally convey worry, sadness and anger. By reducing these signals, the symptoms of depression should improve.
They designed a study in which one group of people suffering with depression were injected with botox into their frown muscles at a dose that would normally immobilise the muscle. Another group of people, who also suffered with depression were injected with a placebo, salt water. At the end of the study, the botox group recorded almost a 50% reduction in their symptoms of depression. The study's results were so impressive that Allergan, the company that produces Botox, has asked the FDA for approval to run large scale, late stage clinical trials on the use of botox in depression.
This is big news for several reasons. One in five people in the UK suffers with depression, a condition that can be debilitating and for some, lifelong. Depression also has devastating consequences for the society at large, with an estimated £2.4 billion lost to the economy each year due to absenteeism from work. Most antidepressants work by increasing the level of the " happy" hormone, serotonin, that is available for the brain to use. Unfortunately traditional treatments can fail in up to 50 % of cases, and antidepresants are associated with a long list of unpleasant side effects such as low sex drive, erectile dysfunction, weight gain and insomnia.
Unknown to many, Botox already has more uses in the medical field than in the cosmetic. It is used to treat migraines, overactive bladders, excessive sweating and muscle spams just to name a few. Hence adding it to the arsenal for depression is not that far-fetched. If botox was to be approved for use in depression, it would not be associated with the list of side-effects that traditional antidepressants have, because botox remains local to where it has been injected. Interestingly, twice as many women suffer with depression than men and for women who are already more likely than men to have botox injections, this might be of particular benefit.
For the time being, Botox has not been approved for use by any regulatory body in the world for depression. I would strongly advise anyone with depression, not to stop their precribed antidepressants without medical advice. However, I am quite excited to see where this wonder drug is headed.
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