Botulinum Toxin for Depression

Botulinum toxin is a type of treatment, called a neuromodulator, that was first approved by the FDA in 1989 and has been used for a wide range of medical conditions, such as excessive sweating, spastic bladder, crossed eyes, excessive blinking, headaches, and uncontrolled movement disorders. Although botulinum toxin is commonly used for medical conditions, it is probably most well-known for its cosmetic applications of reducing wrinkles. All of the different patented forms of botulinum toxin are approved for use in the glabella, which is the area between the eyebrows. In addition to the medical and cosmetic uses, there is some evidence that it can have psychological usages as well. There is increasing research to show whether or not botulinum toxin can be useful for people who suffer from depression. 

Botulinum Toxin Helps Depression

Initially, it is easy to think that botulinum toxin could help with depression simply because the patients feel better about the way they look, but it can actually be deeper than that. A meta-analysis, which is a type of study that combines and summarizes multiple studies on a topic, showed that botulinum toxin can offer significant improvement in symptoms of depression and is considered a safe adjunctive treatment for patients who are receiving pharmaceutical treatment for depression.^[1] 

How Does Botulinum Toxin Work?

It has been suggested that the temporary paralysis of facial muscles may improve depression through a change of proprioceptive feedback mechanisms.^[2] This suggests that when a person is physically unable to use the muscles that are commonly used while they are frustrated or depressed, there is essentially a rewiring within the neurological connections that actually causes a reduction of depression. A single treatment with botulinum toxin in the frown lines of the glabella (between the eyebrows) may lead to a quick, strong, and sustained improvement in depressive symptoms.^[2] 

It is also possible for botulinum toxin to indirectly help reduce depression by lessening symptoms of difficult or frustrating conditions. Botulinum toxin is frequently used to treat migraine headaches, and numerous studies have shown that it can improve quality of life^[3] along with other psychiatric complaints, including depression, for patients with these debilitating types of headaches.^[4-6] Women with multiple sclerosis were given botulinum toxin injections to improve sexual function, and the researchers found that a side effect of treatment was that patients had reduced depression.^[7] 

With ongoing research on the use of botulinum toxin for the treatment of depression, we are likely to discover the physiologic reasons for the benefits. For now, we can simply recognize that some people either directly or indirectly have a reduction in symptoms of depression with the use of botulinum toxin. As with any form of treatment, there are potential side effects with its use, and every patient should have a consultation with a trained professional prior to treatment.

1.  Parsaik AK, Mascarenhas SS, Hashmi A, et al. Role of Botulinum Toxin in Depression. J Psychiatr Pract.2016;22(2):99-110; PMID: 27138078 Link to research.
2. Kruger TH, Wollmer MA. Depression--An emerging indication for botulinum toxin treatment. Toxicon.2015;107(Pt A):154-157; PMID: 26415901 Link to research.
3. Kollewe K, Escher CM, Wulff DU, et al. Long-term treatment of chronic migraine with OnabotulinumtoxinA: efficacy, quality of life and tolerability in a real-life setting. J Neural Transm (Vienna).2016;123(5):533-540; PMID: 27032774 Link to research.
4. Demiryurek BE, Ertem DH, Tekin A, et al. Effects of onabotulinumtoxinA treatment on efficacy, depression, anxiety, and disability in Turkish patients with chronic migraine. Neurol Sci.2016;37(11):1779-1784; PMID: 27418178 Link to research.
5. Maasumi K, Thompson NR, Kriegler JS, et al. Effect of OnabotulinumtoxinA Injection on Depression in Chronic Migraine. Headache.2015;55(9):1218-1224; PMID: 26381856 Link to research.
6. Boudreau GP, Grosberg BM, McAllister PJ, et al. Prophylactic onabotulinumtoxinA in patients with chronic migraine and comorbid depression: An open-label, multicenter, pilot study of efficacy, safety and effect on headache-related disability, depression, and anxiety. Int J Gen Med.2015;8:79-86; PMID: 25733924 Link to research.
7. Giannantoni A, Proietti S, Giusti G, et al. OnabotulinumtoxinA intradetrusorial injections improve sexual function in female patients affected by multiple sclerosis: preliminary results. World J Urol.2015;33(12):2095-2101; PMID: 25966660 Link to research.