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Depression is one of the most common psychological illnesses faced by large majority of people, all across the globe. According to the reports of Mental Health Foundation UK, 1 in every 5 adults is likely to experience depression during the course of the year and it is more prevalent among women than in men.(source: www.mentalhealth.org.uk/help-information/mental-health-statistics/

National Institute For Clinical Excellence, 2003). In USA, 1 in every 10 adults suffers from depression and women are twice vulnerable to it as compared to that of men. When we feel distraught, we develop a frowned and depressed expression on our face giving a clear indication that we are feeling distressed.

To us, the feelings of depression cause the sad and frowned look on our face but could this be other way around? Is it possible that a sad look on the face causes a depressed and low mood?

By thinking about the mood from a different perspective would lead towards the revolutionary implications to develop understanding about the causes of low and distressed moods and also for the depression treatment.

Botox and depressed facial expression

Botox is known for treating the expression lines which appear on our face as a result of ageing. These lines are also formed on our forehead and around our mouth giving a sad and depressed expression during stressed state. One of the common complaints about the Botox anti-wrinkle treatment which many of the recipients have is that they feel it difficult to display their emotions through expressions. This is the side effect of Botox however it may prove to be good for the people having depression.

Researchers have been trying to probe the question if Botox can help in treating depression as it treats those facial lines associated with the low mood expressions?

Recently various studies has been conducted which found that as facial muscles are linked with inducing depressed mood, injecting Botox into those muscles alleviate the feelings of depression. A study conducted by Prof. Kruger and his colleagues was presented at the annual meeting of American Psychiatric Association 2014. The study results showed that there have been positive improvements in the mood of the study participants who had been given Botox treatment for the frown lines; the area between the eyebrows and just above the nose.

(source: www.webmd.com/depression/news/20140619/botox-depression)

The most commonly performed procedure in aesthetic treatments is the injection of Botulinum Toxin into the Glabellar area (the region just above the nose and in-between the eyebrows). The toxin blocks the movements of the Corrugator and Procerus muscles located in this region. In aesthetic treatments, this effect is used for treating ‘frown lines’.

Muscles involved in creating frowning and distressed expression

The Corrugator muscle is located at the eyebrow corners close to the nose. It is responsible for the downward pull of the eyebrows and towards the nose, resulting in creating vertical forehead wrinkles. It is referred to as ‘frowning muscle’ and can be considered as a key muscle in distressing expression. The other muscle involved in creating distressing expression when we feel upset is ‘Procerus muscle’. It stretches from the lower portion of nasal bone towards the area between the eyebrows, pulling the skin between eyebrows in the downward direction. So it leads to the formation of transverse lines on forehead. These muscles are generally targeted during the Botox anti-wrinkle treatment.

These muscles create ‘the omega sign of depression’ as during frowning and melancholic state, they form a Greek letter omega. This has been well-known since the Victorian era when the diagnosis of depression used to be given by the appearance of ‘Omega Sign’.

This shows that the above part of the face has been associated with depression even before the contemporary science happens to re-discover it. William James a renowned and eminent professor of psychology, in 1980 said,

“Refuse to express a passion, and it dies”.

This suggests a strong support that there exists a mutual interaction between the activity of emotions and facial muscles. One of the major breakthroughs in studying the effect of Botox in relieving depression has been a research study conducted by Dr. Eric Finzi and Dr. Norman E.Rosenthal. The subjects chosen for the study were the patients suffering from chronic depression. The findings of this largest study to date on analyzing the effects of Botulinum Toxin on depression discovered that almost 52% of the participants suffering from the moderate to severe levels of depression expressed feeling relief from the depression after receiving Botox injections in the Glabellar region between the eyes

(source:Finzi,E. & Rosenthal, N. ( 2014). Treatment of depression with onabotulinumtoxinA: A randomized, double-blind, placebo controlled trial”. Journal of Psychiatric Research, Volume 52 (May 2014).

These and other similar findings offer a positive ray of hope for the patients suffering from chronic depression for years in which adherence to the other psychological therapeutic interventions is poor and is a serious issue in treating depressed patients

(source: Serna et al. 2010. Duration and adherence of antidepressant treatment (2003–2007) based on prescription database. European Psychiatry, 25 (2010), pp. 206–213).

In addition to poor adherence, psychological therapies for depression require long periods of treatment so Botox prove to be a quick and economical option. The record of tolerability and safety of Botulinum toxin in the glabellar area is also outstanding so it seems to be a promising treatment for chronic depression

(Brin, et al. 2009. Safety and tolerability of onabotulinumtoxinA in the treatment of facial lines: a meta-analysis of individual patient data from global clinical registration studies in 1678 participants. Journal of the American Academy of Dermatology, 61 (2009), pp. 961–970.e1-11)

Another research study, conducted by Wollmer and colleagues(May 2012) further supports the effectiveness of Botox in treating depression. The study offers evidence that the injection of Botulinum toxin to the glabellar area may prove to be a sustainable, effective and safe option for treating depression. It also offered a clinical support to the concept that the facial muscles not just express emotions but also helps in regulating mood states

(Wollmer, A. et al. 2012. Facing depression with botulinum toxin: A randomized controlled trial.Journal of Psychiatric Research. Volume 46, Issue 5, May 2012, Pages 574–581).

Final thoughts!

All these clinical research studies and evidences points toward the positive direction of adding a new treatment to the Botox treatments list that is for depression, in near future. It is good news for those suffering from years of depression or depressive symptoms. Botox injection in the Glabellar region will not only take away some years of their age but will also likely to cheer up their mood and will alleviate stress.

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