Veraguth’s Fold - This triangular shaped fold of the forehead is associated with depression
Botox treatment for Depression
As a fully qualified Psychiatrist and member of the Royal College of Psychiatry as well as a GMC registered and practicing Aesthetic Doctor I have always been aware of the clear relationship between aesthetic and psychological medicine. Many people undergo cosmetic procedures to improve their self-image and as a result their self-confidence and the way they are perceived by others, the link between this and a person’s underlying mental state is undeniable and should always be taken into account by Aesthetic Physicians.
The nature of the connection between mind and body is a complex one and one that has been theorised on for centuries. In Expression of the Emotions, Darwin theorised that there were specific physiological facial signs that were diagnostic of a patients underlying mental-state and in particular a depressive state, he noted ‘peculiar furrows formed on the forehead. These muscles... may be called, for the sake of brevity, the grief-muscles’
His insights would not be out of place in modern psychiatry that uses biological markers to both diagnose and treat symptoms of mental health ‘the links are indeed wonderful which connect cause and effect in giving rise to various expressions on the human countenance’.
The biofeedback loop between facial expressions and emotions
When people experience emotions, one of the first things that happen is a change in expression. The expression is caused by the emotion, but also becomes a reaction to it, “amplifying” the feeling. This includes negative feelings like sadness and anxiety. With Botox, it becomes possible to paralyse some facial muscles responsible for expressions. This interferes with the “biofeedback loop” also referred to as “Facial Feedback” between the face and brain. Patients have reported that, following injections, negative emotions are weaker than before and pass more quickly.
Clinical studies have shown that botulinum toxin A could be used as an antidepressant by inhibiting frowning in patients with major depression. In a study by Finzi, patients who met DSM-IV criteria for ongoing major depression in spite of pharmacologic or psychotherapeutic treatment were evaluated with the Beck Depression Inventory (BDI-II) before receiving botulinum toxin A to their glabellar frown lines (just above the nose and between the eyes). Two months later, all patients were re-evaluated clinically and with the BDI-II. Nine of the 10 patients were no longer clinically depressed 2 months after treatment. This study also showed the complete resolution of the omega melancholium sign and Veraguth’s fold in a patient after treatment with botulinum toxin A.
Specific facial features may be integral components of depression and anxiety, and may therefore be targeted with as much benefit as an entirely new approach to the treatment of clinically low mood. In an era of modern medicine which is keenly searching for biological indicators of disease, the relationship between facial expression and mood is a scientifically valid and exciting area of potential treatment.
Using Botox to help us frown less may just be the latest scientifically validated treatment for depression.
References and articles of interest:
Darwin’s contribution to Psychiatry
Antidepressant effects of botulinum toxin A: scientific rationale
Can Botox treat Depression?
Treatment of depression with botulinum toxin A: a case series.