Botox injections may ease depression.

07/30/2020 Health


Doctors inject Botox to smooth facial wrinkles and treat health problems such as severe sweating, uncontrollable blinking, chronic migraines, overactive bladders, and neurological disorders that cause muscle contractions and neck and shoulder pain.

Botox, a drug made from a toxin produced by the Clostridium botulinum bacteria, works by weakening or paralyzing specific muscles or blocking certain nerves.
More than 264 million people worldwide suffer from depression. But common treatments for depression aren’t effective for nearly a third of these people, even when they stick to their treatment plans and tolerate the drugs, according to the study, published Thursday in the journal Scientific Reports.
This deficiency has led doctors to explore alternative treatments, such as doses of psilocybin (the active ingredient in psychedelic mushrooms), ketamine infusions, and, more recently, Botox injections. Previous studies of the past 15 years have found that the drug could have antidepressant effects.
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It is unclear how and for how long treatment for depression might work, but researchers have thought that Botox may interrupt a feedback loop between negative facial expressions in the glabellar region, behind the skin between the eyebrows, and above the nose, where our “muscle aches” are – and negative emotions. Because of this hypothesis, those studies primarily used forehead injections to treat depression, but were limited in terms of sample size, unstable methodologies, injection sites, and mixed results.

Botox for different conditions

To address the limitations of previous studies, the researchers analyzed more than 45,000 reports of adverse events resulting from Botox treatments from the United States Food and Drug Administration’s Adverse Event Reporting System. The system supports monitoring of adverse drug effects reported by patients, healthcare professionals, and drug manufacturers to the FDA through MedWatch, the FDA’s Adverse Information Reporting and Safety Events Program.
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They divided the patients into eight groups corresponding to the medical symptoms most frequently treated with Botox. These were:

  • cosmetic use for wrinkles, facelifts, dermal fillers or more
  • migraine
  • spasms or spasticity of the extremities (when muscles tense or tense and prevent movement, speech, and gait)
  • Neck Pain
  • involuntary blinking or spasms of your eyelids
  • excessive sweating
  • excessive drooling
  • neurological and urinary disorders of the bladder

Each cohort was separated into two groups, in which one group received Botox for their conditions and the other did not. Patients who received Botox injections to treat excessive sweating, facial wrinkles, migraine, spasticity, and spasms reported depression between 40% and 88% less frequently than people who underwent different treatments for the same conditions.

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“We found that (the effect) does not depend on the injection location and does not depend on the (medical conditions), which are quite diverse for Botox,” said Ruben Abagyan, lead author of the study and Professor at the College of Pharmacy and Sciences. Skaggs Pharmaceuticals, University of California, San Diego.

“The implications of that are fascinating because it means that depression can be cured with different (means) and not necessarily by injection into one of the facial muscles, which may be unwanted in some cases,” added Abagyan.

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Although the facial feedback loop hypothesis is a “proven and plausible mechanism,” according to the study, the findings may suggest that there are other, more complex ways through which Botox could have an antidepressant effect.

Botox could be transported to the structures of the central nervous system that participate in the regulation of our mood and emotions. A 2019 study found that Botox injections for muscle spasms can go beyond the injection site and affect opposing muscle groups and reflexes through changing neuronal activity.

“A fraction of that is distributed systemically through the bloodstream … and then somehow enters the brain and perhaps affects different places” that could be related to depression, Abagyan said.

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The interaction between muscles and mood is not limited to the facial feedback process.

Muscle tension in various regions of the body is a common symptom of depression and can be both a physical manifestation of the disorder and a reinforcement of depressed mood. That’s why progressive muscle relaxation, which mentally relaxes a person by tensing and then relaxing their muscles, is an established treatment in the field of psychiatry.
Depression is associated with an increase in muscle tone, which describes the maintenance of partial contraction of the muscles. Reduced muscle tone as a result of Botox injections, which weaken the muscles, could counteract depression.

“Imagine that when you get depressed, not just a location on your forehead, which forms this wrinkle, but all your muscles get stressed and contracted,” Abagyan said. “So there is a distributed muscle memory. By breaking that memory by basically relaxing them, the feedback between the head and the muscles is broken in this case.”

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Since some of these conditions are chronic and heavy, they can cause secondary psychiatric problems like depression. If Botox solved these problems, that could have alleviated depression.

“This study makes me wonder if having muscle spasms or sweating can also give us a physical feeling of depression, and by treating this ‘feeling of depression’ we can affect not only the patient’s medical problem (but also) their psychological well-being.” Dr. Jason Reichenberg, a dermatologist at the Ascension Medical Group and an associate professor of internal medicine at the University of Texas at Austin, said in an email. Reichenberg was not involved in the study.

The future of Botox

Since the FDA reporting system is voluntary and open to the public, negative reactions to Botox may have been underestimated and biased, according to the study. Other details related to demographics, dosages and duration of treatment, medical records, and other medications or supplements were also limited.

Past data studies cannot establish “a cause and effect relationship, but they help us focus our future research,” Reichenberg said. “The results are even more impressive when you realize that the authors eliminated patients taking antidepressants so as not to be biased; their results could have been even stronger if they had saved those other data.”

The researchers suggested that Botox injections could be an alternative treatment for those who have no luck with common depression treatments, and also for those experiencing chronic conditions and depression.

“If someone needs to be treated for excessive salivation, spasms, or bowed head and is depressed at the same time, the discovery shows that (Botox) can be beneficial for both indications,” Abagyan said. “If you can kill two birds with one stone, I think it’s definitely something to consider.”

Depression carries dangers like suicide risk, but also Botox injections if the doses are disproportionate to what patients can handle, Abagyan said. Additional studies on Botox treatment for depression are needed to understand the possible side effects and ensure that it is a safe path to mental well-being.

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