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Depression affects around 280 million people worldwide, with women twice as likely to suffer as men.1 The condition negatively affects quality of life and is often underdiagnosed and undertreated. Despite various antidepressant treatments, about 1/3 of patients remain symptomatic.2
Recent research has explored the potential of botulinum toxin A (BTA) as an alternative treatment. BTA can affect facial expressions by paralyzing the psoas muscles involved in frowning. The researchers hypothesized that this intervention might disrupt the facial negative feedback loop associated with depression, possibly improving mood and reducing amygdala activity associated with negative emotional reactions. Additionally, the researchers observed that this disruption in the loop it can create an overall more positive aesthetic presentation, leading to more self-confidence.3-4
Recent study findings show that BTA injections not only improve the appearance of frown lines, but may also improve mood and overall quality of life.5 A recent study aimed to further investigate the effects of BTA in non-depressed individuals, focusing on its impact on happiness and quality of life.6
Methods
The study involved 87 patients, ages 18 to 70, seeking BTA for facial wrinkles. The study excluded patients with a history of neuromuscular disease, recent facial cosmetic surgery within the past 3 months, history of suicide attempt, major depression, other psychiatric illnesses (such as diagnosed OCD, schizophrenia, or bipolar disorder), or use of any psychiatric medications, pregnancy, and lactation. Patients received 500 units of BTA diluted in saline and their quality of life and happiness were assessed using the WHOQOL-BREF and Oxford Happiness questionnaires before and 1 month after treatment. The WHOQOL-BREF measures physical, psychological, social and environmental health using a 26-item questionnaire scored on a 5-point scale which is then translated to a 0–100 scale for standardized assessment. The Oxford Happiness Questionnaire assesses overall happiness using a 29-item questionnaire rated on a 6-point scale ranging from strongly agree to strongly disagree.
Results
The researchers found no significant difference in mean quality of life scores (p > 0.05) after BTA injections for either sex. However, they reported a significant difference in mean post-procedure happiness values (p = 0.001), with no significant gender differences in happiness outcomes (p > 0.05).
This aligns with existing research suggesting that facial expressions and the feedback they generate can influence mood and emotions. By enhancing facial expression and disrupting negative emotional feedback, BTA injections appear to improve mood and boost self-confidence.3 However, the lack of significant change in quality of life was unexpected, given that improved mood and self-confidence are commonly associated with better quality of life.7 The researchers suggested that the short follow-up period of 1 month may have been insufficient to detect any substantial improvement in quality of life. Previous studies focus mainly on BTA for patients with depression, whereas this study targeted those seeking cosmetic improvements. The study said this difference in focus means the results may not translate directly to patients with clinical mood disorders.
Conclusion
This study provides initial evidence supporting the potential mood-enhancing benefits of BTA in cosmetic contexts, suggesting that it could have adjunctive value in the treatment of mood disorders. The researchers said that understanding the phenomenon of happiness can help assess the interplay between facial expressions and emotions, but it is only one piece of the puzzle for understanding human psychology and well-being. They suggested that further research is needed to confirm the study’s findings and explore the role of BTA in therapeutic settings for depression and related conditions.
References
- Cui L, Li S, Wang S, et al. Major depressive disorder: hypothesis, mechanism, prevention and treatment. Signal transmission target Ther. 2024? 9(1): 30. Published February 9, 2024. doi:10.1038/s41392-024-01738-y
- Amado-Boccara I, Donnet D, Olié JP. The concept of psychology [The concept of mood in psychology]. Brain. 1993, 19(2):117-122.
- Izard CE. Facial expressions and emotion regulation. J Pers Soc Psychol.1990, 58(3):487-498. doi:10.1037//0022-3514.58.3.487
- Wollmer MA, Magid M, Kruger THC, et al. Treatment of depression with botulinum toxin. Toxins (Basel). 2022;14(6):383. Posted 2022, May 31. doi:10.3390/toxins14060383
- Lewis MB, Bowler PJ. Cosmetic treatment with botulinum toxin is associated with a more positive mood. J Cosmet Dermatol. 2009? 8 (1): 24-26. doi:10.1111/j.1473-2165.2009.00419.x
- Roohaninasab M, Mansouri P, Shariati B, et al. The effect of facial BOTOX injection on quality of life and happiness, a descriptive/prevalence study. Health Sci Rep. 2024? 7:e2303. doi:10.1002/hsr2.2303
- Bonomi AE, Patrick DL, Bushnell DM, et al. Validation of the United States version of the World Health Organization Quality of Life (WHOQOL) instrument. J Clin Epidemiol. 2000, 53 (1): 1-12. doi:10.1016/s0895-4356(99)00123-7
