Depressed About Wrinkles? BOTOX Can Help

The signs of aging can never seem to escape us: your eyes get puffier, your wrinkles lines extend in length, and the creases at the corners of your mouth deepen substantially. Soon, you remember a friend’s nonchalant remark that you seem to look angry all the time…even when you’re smiling.  Perhaps you are angry, both angry and sad that your youthful vigilance has come and gone all too quickly. Thankfully, there may be one treatment available that can offer a boost to your spirits: a recent study published in the Journal of Psychiatric Research reported that single treatment of age lines with botulinium toxin A (BTX-A or BOTOX) may alleviate depressive symptoms in patients who do not improve sufficiently on previous medication.

According to the World Health Organization (WHO), depression is one of the leading causes of disability, affecting as much as 121 million people worldwide. Although there are various effective treatments available, some patients register unsatisfactory responses to therapy causing their depression to enter into chronicity. Negative emotions such as anger, fear and sadness are prevalent facial expressions in depression that are associated with activation of the corrugator and procerus muscles in the glabellar region of the face. Injection of BTX-A to this facial region has been previously used to inhibit the activity of the corrugator and procerus muscles for the cosmetic treatment of frown lines. Unexpectedly, recipients of this treatment have also reported an increase in emotional wellbeing beyond the desired cosmetic benefit. Specifically, reduced levels of fear and sadness have been observed.

Taking these findings into account, the capacity for BTX-A to counteract negative emotions may also have clinical implications. To explore whether the attenuation of facial psychomotor features associated with depression may produce alleviation of affective symptoms, Wolmer et al. recently conducted a randomized controlled trial of BTX-A injection to the glabellar region as an adjunctive treatment of major depression. Thirty subjects, both men and women were included into the study and randomly assigned to treatment or placebo group. Subjects were included if their age ranged from ages 25-65 years old, had a diagnosis of on-going major depressive disorder according to the DSM-IV, and exhibited moderate to severe vertical glabellar lines during maximum voluntary frowning.

At baseline, the treatment and placebo group did not differ in any of the collected characteristics.  However, the treatment group showed a significant improvement in depressive symptoms compared to the placebo group at the 16-week follow-up mark, measured by the Hamilton Depression Rating Scale (HAM-D). Even after only one BTX-A treatment at the 6 week mark, BTX-A recipients’ depression scores were reduced on average by 47.1% compared to only 9.2% in placebo-treated participants. The authors concluded that a single treatment of the glabellar region with BTX-A may shortly accomplish a strong and sustained alleviation of depression in patients, although the mechanism of such effect has yet to be elucidated.

Although the mechanisms remain unclear, the authors do not attribute aesthetic benefit as a major contributor to mood improvement as they did not enroll patients into the study who were cosmetically concerned about their frown lines. Notably, treatment response also did not depend on a positive appraisal of the cosmetic change. However, the authors believe that it is possible that a more positive facial expression and improved feedback both from one’s own face in the mirror and from social interaction partners may have contributed to mood enhancement.

What does this mean for the future of BTX-A and its clinical applications? It is possible to extend these findings onto other muscles in the lower sections of the face (e.g. depressor angulis oris and mentalis muscles) and examine any mood-elevating effects.  Modulation of mood states with BTX-A may also be effective in the treatment of other clinical conditions involving negative emotions, like anxiety disorders. If true, findings from these studies would support the concept that facial musculature can not only express, but regulate mood states as well.

References

Gilmer WS, Trivedi MH, Rush AJ, Wisniewski SR, Luther J, Howland RH, Yohanna D, Khan A, & Alpert J (2005). Factors associated with chronic depressive episodes: a preliminary report from the STAR-D project. Acta psychiatrica Scandinavica, 112 (6), 425-33 PMID: 16279871

Lewis MB, & Bowler PJ (2009). Botulinum toxin cosmetic therapy correlates with a more positive mood. Journal of cosmetic dermatology, 8 (1), 24-6 PMID: 19250162

Sommer B, Zschocke I, Bergfeld D, Sattler G, & Augustin M (2003). Satisfaction of patients after treatment with botulinum toxin for dynamic facial lines. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 29 (5), 456-60 PMID: 12752511

Wollmer MA, de Boer C, Kalak N, Beck J, Götz T, Schmidt T, Hodzic M, Bayer U, Kollmann T, Kollewe K, Sönmez D, Duntsch K, Haug MD, Schedlowski M, Hatzinger M, Dressler D, Brand S, Holsboer-Trachsler E, & Kruger TH (2012). Facing depression with botulinum toxin: a randomized controlled trial. Journal of psychiatric research, 46 (5), 574-81 PMID: 22364892

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