Does Botox help OR cause depression?

DUBLIN - May 6, 2013 - PRLog -- A recent article by Claire Coleman in the Daily Mail has led to much confusion regarding differing opinion as to role of Botox in treating or causing depression. The article was based on a study led by Dr Michael Lewis of the School of Psychology, Cardiff, Wales, who followed 25 people who had received Botox for facial lines and examined the idea of facial feedback - where the expression we make with our faces affect how we feel.
Previous studies have found that the treatment of frown lines left patients feeling less depressed. In 2006, Dr. Eric Finzi and Dr. Erika Wasserman reported in Dermatologic Surgery that treating clinically depressed patients with Botox on their frown lines actually got rid of their depression (http://www.medicalnewstoday.com/articles/43776.php). Hennenlotter (2009) went one stage further and showed that botulinum toxin treatment to the central frown lines stopped the activation of specific brain regions normally seen during voluntary contraction of the frown muscles. corrugator and procerus muscles. This indicated that feedback from the facial musculature in this region in some way modulated the processing of emotions. Many other researchers have continued down this road with many researchers speculating that the treatment interfered with the ability to decode the facial expression of other people.

More recently, two centres, the Psychiatric University Hospital of the University of Basel, Switzerland and the Medical School Hannover, Germany conducted a randomised, placebo-controlled, double-blind trial. The authors concluded for the first time that a single botulinum treatment of the glabellar region with could reduce the symptoms of major depression. This effect developed within few weeks and persisted until the end of the sixteen-week follow-up period. The effect sizes in the study were large and the response and remission rates were high. So who is right?

Believe it or not – both are and the answer to the apparent medical paradox lies with Charles Darwin!

In 1872, the great explorer stated that the expression of sadness was attributed to the activity of so-called ‘grief muscles’ in the glabellar region. He formulated a new theory in his book ‘The Expression of the Emotions in Man and Animals’ concerning genetically determined aspects of behaviour. The book was published thirteen years after ‘On The Origin of Species’ and is, alongside his 1871 book The Descent of Man, Darwin's main consideration of human origins. In this book, Darwin seeks to trace the animal origins of human characteristics, such as the tightening of the muscles around the eyes in anger and efforts of memory. Darwin even sought out the opinions of some eminent British psychiatrists in the preparation of the book, which forms Darwin's main contribution to psychology. His theory called the ‘facial feedback hypothesis’, implied a mutual interaction between emotions and facial muscle activity. There is experimental evidence that voluntary contraction of facial muscles can channel emotions, which are conversely expressed by activation of these muscles. It is assumed that reduced proprioceptive feedback from the paralyzed facial muscles is a relevant mechanism of mood improvement and this is why it can be used to reduce depression.

However, Dr. Lewis and team found that people treated for another muscle (around the crows' feet) left patients feeling more depressed.

This does not contravene Charles Darwin’s original hypotheses, in fact it supports it. The muscles around the eye are related to happiness and smiling and to restrict their movement must interfere with the ‘facial feedback hypotheses in a converse way to the ones in the frown area. We can only assume that reduced proprioceptive feedback from these paralyzed facial muscles is a relevant mechanism of mood disimprovement improvement and this is why they may increase depression. Accordingly, happiness can make you smile and smiling can make you happy.

It is obvious that the facial musculature not only expresses, but also regulates, mood states. Botulinum toxin injection interferes with the ‘facial feedback hypothesis’ originally postulated by Charles Darwin. We must remember that botulinum toxin to the glabellar region may be an effective, safe, and sustainable intervention in the treatment of depression. The reason for this has not yet been fully evaluated but we must consider the concept as depression affects over 120 million people globally, making it one of the leading causes of disability in the world. Because of the long treatment intervals it may also be an economic treatment option and the safety and tolerability record of botulinum toxin injections to the frown area region is excellent.

Maybe, it was my sixth sense but I never really felt right about totally removing crow’s feet around patient’s eyes.