Botox injections may help relieve symptoms of mental health conditions such as depression and anxiety, the results of a new study suggest.
Botulinum toxin (BTX) injections, often shortened to Botox, are used primarily for cosmetic procedures as they cause the muscles to relax. When applied to certain areas of the face, Botox can smooth lines and wrinkles.
This relaxation of facial muscles has been the subject of a number of studies, with researchers looking to find out if it could be used to relieve symptoms of mental health conditions.
Specifically, the idea is to target what evolutionary biologist Charles Darwin called “pain muscles.”
“This whole field of research using botulinum toxin as a treatment for mental disorders is based on the facial feedback hypothesis,” Dr. Axel Wollmer, an expert in psychiatry and a researcher at Semmelweis University in Budapest, told Euronews Next. lead author of the study.
He said that this hypothesis dates back to Darwin and William James (known as the “father” of American psychology) in the 19th century.
He states that our facial expressions not only communicate our emotional state to others, but also to ourselves.
The theory is that while certain facial expressions like frowning are caused by negative emotions, the facial expressions themselves actually reinforce those feelings in a vicious cycle.
“Then one reinforces the other and maybe increases to a critical level of emotional arousal that can be a problem in mental health conditions,” Wollmer said.
Relax the ‘pain muscles’
Together with researchers from the Hannover School of Medicine in Germany, Wollmer and her team set out to build on previous research on Botox injections in the glabellar region, the area of the face above the nose and between the eyebrows, which people often They tense up when experiencing negative emotions.
“Once we activate facial muscles to express an emotion, we generate a proprioceptive signal that goes from the face to the emotional brain that reinforces and maintains this emotional state,” Wollmer said.
“Just by embodying this emotion, we really feel it as a warm and complete emotion. And once we suppress this incarnation, the emotion subsides and is no longer perceived as such.”
The scientists wanted to capture what happens in the brain when this positive feedback loop is broken, relaxing the grief muscles. For this study, they looked at 45 female patients with borderline personality disorder (BPD), one of the most common personality disorders.
The team explained that patients suffering from BPD experience an “excess of negative emotions,” such as anger and fear. Wollmer said BPD patients are “in a sense, the prototype of being overwhelmed over and over again by a series of negative emotions that you really can’t control.”
Some of the research participants received Botox injections, while a control group received acupuncture.
Before treatment and four weeks afterward, participants were given a so-called emotional go/no-go task, in which they had to monitor their reactions to certain cues while viewing images of faces with different emotional expressions.
This was done while the researchers scanned their brains using functional magnetic resonance imaging (MRI).
This trial returned mixed results: Both Botox and acupuncture patients showed similar improvement after treatment, but the team was encouraged by two other findings.
calm the amygdala
With MRIs, they demonstrated for the first time how Botox could modify the neurobiological aspects of BPD.
The images showed a reduction in the activity of the amygdala region of the brain in response to emotional stimuli.
“We found a calming effect on the amygdala, which is highly involved in processing negative emotions and is overactive in borderline patients,” Wollmer said. This, she added, was not seen in the control group treated with acupuncture.
The researchers also noted that Botox reduced patients’ impulsive behavior on the go-no-go task, and correlated with activation of prefrontal areas in the brain that are involved in inhibitory control.
The limitations of the study are its small size, only 45 participants, and the fact that they were probably able to tell whether they were receiving acupuncture or actual Botox injections because the effects of Botox are so obvious.
Botox to treat depression?
Previous research has looked at how Botox injections can break feedback loops in other regions of the face and body.
A 2021 studywhich analyzed data from 40,000 Botox patients in the US Food and Drug Administration database, found that anxiety disorders were 22 percent to 72 percent less common than in patients who had received other therapies for the same conditions.
Similar research was conducted in 2020 on the possible antidepressant effects of Botox injections, which showed that they could be used not only to treat depression, as several previous studies had already suggested, but that they could also have a protective effect against the disease.
“As has been shown before in healthy volunteers, there are some changes in the structure of the brain that are very important for the processing of negative emotions. And this, of course, is also critical for depression,” Wollmer said.
He added that established treatments, such as psychotherapy or antidepressants, don’t work well enough for about a third of depressed patients, “so new treatment options need to be developed, and this is where BTX injections could have a role.
Wollmer, who has served on an advisory board for Botox maker Allergan, would like to see more researched findings in a large phase III clinical trial.
From then on, he said, researchers could see if other mental health conditions could be addressed with this approach.
The joint study was published in Scientific Reports magazine.
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