Can Botox lift a bad mood? Maybe, research suggests

I was late to the botox party. While many of my friends in their forties and fifties were smoothing their brows and furrows, I was too chicken to join them, even though I admired their seemingly rested faces.

The source of my reluctance? A woman who lives on my street has such a blank face from too much botox (which uses botulinum toxin, a drug for therapeutic and cosmetic purposes, per StatPearls) that she looks “frozen”. In other words, I doubt she could move her upper face if she tried. I certainly didn’t want that to happen to me.

But after getting tired of seeing what I called “the trenches on my forehead” on video calls during the pandemic, I decided to take the plunge – er, injections.

Botox Treatment: How it went for me

When I went to see a Maryland-based cosmetic dermatologist recommended by one of my closest friends, I confessed my concerns and told her I really wanted to avoid that frozen look. She was sympathetic and promised to tread lightly.

Then she alternately made me raise my eyebrows and frown as hard as I could as she took pictures of my face. Then we made an interesting discovery: It turns out that I have a hyperactive muscle on the right side of my forehead, which is why my right eyebrow often appears higher than my left in photos, and why the furrows on the right side of my forehead are more pronounced. I always thought I had an unconscious habit of making a funny face while taking my picture because I don’t like being photographed. But it wasn’t me. it was my face, cheaters.

With some judicious botox injections in several places on my forehead, especially on the right side, the doctor took care of this issue, as well as my “twitches”. He had me come back two weeks later for fine tuning.

Can Botox lift a bad mood?

Here’s the remarkable part: After my first treatment, not only did I look more relaxed, but I felt more relaxed. I am prone to anxiety and after starting the injections I felt noticeably calmer. It wasn’t that the stress in my life had disappeared – on the contrary, new sources had emerged in those two weeks – but I felt less reactive to them. My mood was generally lighter, steadier and more optimistic.

Then I began to wonder: Was some of my anxiety coming from an overactive forehead muscle that was causing me to frown or furrow my brow without realizing it? Or, was something else going on? I decided to investigate.

It turns out that research looked at the effects of botulinum toxin injections on depressed mood and social anxiety — and found positive results. ONE study published in September 2021 at Brain and Behavior found that depressed subjects who received botulinum toxin injections into the frown muscles and other key areas on their face experienced a reduction in depression comparable to those who received sertraline (Zoloft), an SSRI antidepressant, after 12 weeks. In addition, mood improvements occurred earlier for people who received injections.

Previously, one uncontrolled study published in March 2019 Journal of Neurology, Neurosurgery, and Psychiatry looked at the effects of botulinum toxin injections in 715 people with chronic migraines: Over a two-year period, most of the participants experienced a reduction in their headache days, as well as in their symptoms of depression and anxiety (which often accompany these debilitating headaches) . While it may appear that the mood improvements came from a reduction in pain frequency, the researchers observed that reductions in depression and anxiety symptoms occurred even in people who experienced limited reductions in their headache frequency.

And one previous randomized controlled trial found that a single treatment with Botox injections into the frown muscles in the forehead led to a 52% reduction in depression scores among people with major depressive disorder (MDD) six weeks after treatment, but only a 15% reduction in the placebo group , who received saline injections.

How the Facial Feedback Hypothesis Can Play Out

Although the assumption may be that depressed people feel better because they seem more relaxed after receiving these injections, this is not entirely the case. The results likely have to do with the face feedback hypothesis (FFH), an idea introduced by biologist Charles Darwin in 1872 and further explored by philosopher and psychologist William James in 1884, among others, according to research.

“[The facial feedback hypothesis] states that the relationship between internal emotional states and facial expressions is bidirectional,” he says Norman Rosenthal, MD, a clinical professor of psychiatry at Georgetown University School of Medicine in Washington, DC, who has conducted research on the effects of Botox injections on depression and social anxiety. “If you’re sad, it will reflect on your face, but if your face takes on a sad or distressed expression, it will reflect back to your brain and trigger the actual emotion,” explains Dr. Rosenthal. In short, the expressions you make on your face affect your thoughts and feelings.

By paralyzing key muscles in the forehead and forehead, botulinum toxin injections make it nearly impossible to frown. As a result, it is believed that the person cannot send signals of anger, sadness, anxiety or other negative emotions to the brain, so the mind starts to feel better and the depression eases.

The indirect effect of Botox for improved mood

Interestingly, there is even the possibility of positive ripples in other people. ONE review posted in September 2020 Journal of Cosmetic Dermatology suggests that when botulinum toxin injections soften frown lines, it changes the way others respond to you — that is, by reducing theirs negative emotions. “Your expressions and moods have an impact on those around you,” explains lead author, Mark Nestor, MD, PhD, director of the Center for Clinical Aesthetic Research in Aventura, Florida, and professor of dermatology and cutaneous surgery at the University of Miami Miller School of Medicine in Florida. This result is related to “the theory of embodied emotions – the idea that social interactions are about emotional contagion,” explains Dr. Nestor. “When you’re around people who are frowning, you feel bad.” Conversely, when you’re with people who seem relaxed, you might feel more relaxed too.

When I mentioned my experience to my cosmetic dermatologist, she completely believed it. So does Rosenthal. “I’m not surprised that Botox helped your anxiety,” she says. “Although there are no controlled studies showing this effect, anecdotal evidence like yours and theoretical reasons suggest it is possible if not likely.”

Who knows? Maybe my family will feel more relaxed too.

Most people don’t get Botox injections to improve their mood — but they may have that effect as an unexpected perk, as I did. Don’t get me wrong: I don’t feel happy all the time now. I still worry or feel anxious, but the intensity of these feelings has decreased significantly. And although some research shows a link between botulism toxin treatments and improved mental health symptoms, the US Food and Drug Administration (FDA) has not approved Botox, or any other brand of facial injectable, as a treatment for depression, anxiety or any other mental health conditions.

The bottom line

The cosmetic effects of Botox injections aren’t permanent, which means the mood-boosting effects aren’t either. Typically, treatment lasts three to four months, although some people may need injections less often as time goes on, according to American Academy of Dermatology (AAD). And because facial injectables are not FDA-approved to treat mental health conditions, you should always consult your mental health care provider for a proper evaluation and more evidence-based approaches to dealing with serious mental health issues.

From my own experience, I know I felt lighter and more radiant after Botox, but managing my emotional well-being is something I continue to work on in a variety of ways, including regular exercise and mindfulness and gratitude. “Feeling better is a self-perpetuating state,” says Rosenthal. “It encourages people to do positive things for themselves – they might be motivated to meditate, exercise or become more social, for example.” Any of these can have a positive effect on your emotional well-being.

Subscribe to Updates

What's Hot