Botulinum Toxin: Does it have a Place in the Management of Depression?

Excerpt

“‘Cause when you worry your face will frown/And that will bring everybody down/So don’t worry, be happy.” This bit of pop pathophysiology, sung by Bobby McFerrin in the 1988 Grammy Song of the Year [1], has in the past dozen years been taken quite literally in some quarters at the interface of dermatology and psychiatry. The hypothesis is that, by using targeted intramuscular injections of botulinum toxin, type A (onabotulinumtoxinA, BTX-A, Botox) to pharmacologically block frowning, and the associated muscle contractions that lead—along with age—to “worry lines” and facial wrinkles, depression could actually be treated and reversed. This so-called “facial feedback” hypothesis traces back to great nineteenth century thinkers, including Charles Darwin (“repression … of all outward signs softens our emotions”) [2] and William James (“refuse to express a passion, and it dies”) [3], and has evolved into a theory of “emotional proprioception” [4], positing that the muscles of facial expression, responsible for transmitting information to the brain’s emotional circuitry, are appropriate targets of therapeutic intervention. These ideas gained clinical traction with the 2006 publication of an open case series of ten women with major depression who were seeking BTX-A treatment of glabellar frown lines; 2 months after treatment, nine patients were in remission from depression and the tenth was improved [5]. …