Depressed? Maybe Your Psychiatrist Will Prescribe Botox.

Botox makes you happy. So does a new Lexus, but I can’t prescribe that.

Botox® temporarily freezes dynamic lines such as crow’s feet and forehead wrinkles. When Botox is done well, it can raise your eyebrows and make your face appear well rested, younger, happier. Botox also makes it difficult to furrow your brow or frown.

Too much Botox freezes your face, making it expressionless (which could be seen in both winners and losers at the recent Golden Globes: Were they happy? Sad? Shocked? Who could tell?).

Because Botox can make people look better, it’s no surprise that people who get Botox are happier afterwards. A review in the Journal of Drugs in Dermatology actually looked at the cost of treating depressed patients with Botox. Here’s the reasoning: If you cannot frown because of Botox, then your mind will interpert this as you feel less angry or sad. Preliminary studies showed that people treated with Botox had more positive emotions and felt less depressed after their treatment.

While the logic is easily followed (and is emphatically supported by people who ordinarily pay cash for their Botox), the science is absent. There are no studies that show Botox improves depression as compared to placebo, therapy, or antidepressants. Much more research would have to be done to show that there is a real benefit (it would be  interesting to compare Botox to simply giving people $500 in cash and teaching them to frown less).

Depression is a disease and is never fixed quickly. Treating depression always requires effort, often requires therapy, and sometimes requires medication. I doubt that medication will be Botox. Or a new Lexus.

Photo: Geekadman

12 thoughts on “Depressed? Maybe Your Psychiatrist Will Prescribe Botox.”

  1. Hi Dr. Benabio. Interesting post. i’ll Twitt it.
    Q. Do you think that depression will come back when effect Botox subsides?
    Give me $500 every 4 /6 month. I’ll take it, any time. But this is me:)

  2. Unfortunately, this post missed the point of my publication in Drugs in Dermatology. The costs associated with Botox or Dysport are not comparable to a Lexus. In fact, they are more cost effective than most of the anti depressants presently prescribed.
    More importantly, based on the recent publication regarding lack of efficacy with oral antidepressants, it is possible that treatment with botulinum toxins could actually help people feel better. The cost savings for this in terms of improved job performance, self esteem scores and lower overall medical bills associated with depression would be immense and these costs should not be trivialized. Nor should the impact that depression has on the people that suffer from it. I am sure that the millions of people (most of who are women in the prime of their lives) would welcome the opportunity to feel better.
    Kenneth Beer MD

  3. To Dr Kenneth Beer. i think you are talking about SSRI as an antidepressants. we’ve been using them now for more then 20 years and finally have number to show that they are lack of efficacy and actually are dangerous to certain population.
    Do you have numbers or long term studies to show us that Botox is effective and safe for long term use.
    if no, then why should anybody invest to those kind of studies. why not to try vit D, let say 5,000IU daily for 90 days, or walking on the sunny side of the street for 45 min daily for 90 days. its cheaper then Botox. O.K , any way, show us that its really improves job performance and lowers med bill.
    the best

  4. @drbeer
    Thanks for the comment. Perhaps Botox can treat depression. However, there are no good studies to show that it’s effective. The idea that smoothing wrinkles will cure depression, even if true, appears unseemly. The study to determine if Botox is cost effective for depression was done without knowing if Botox actually works, making us dermatologists seem all too eager to believe it. Especially if we drive a Lexus.

  5. @veronica
    Thanks for the comments. Botox seems safe and is effective at smoothing wrinkles. There are no good studies to show that it works on depression.

    There was a great study done at Duke that showed that regular exercise was as good as taking antidepressants to treat depression. Regular exercise would be more cost effective than any treatment, especially given the other health benefits. So frown less and exercise regularly as you can.

  6. @Dr. Benabio
    I second this! People should realize that expensive doesn’t necessarily mean more effective. Instead of Botox, all one needs is a healthy diet, some exercise and company of loved ones to treat depression!

  7. But Botox is much cheaper than a Lexus! I have to admit, I love a bit of Botox a few times a year as I like how it smooths out my skin. I can’t see my GP prescribing it for depression though.

  8. Non-surgical Treatment of the Peri-oral Soft Tissues and TMJ / TMD Symptoms-
    The Rationale For the Use of Botox and Facial Fillers by General Dentists

    The appearance and function of the peri-oral soft tissues is critical to the preservation and appearance of the dentition.

    Many dental restorative and cases are enhanced and benefit from treatment of the peri-oral soft tissues with the proper utilization of facial fillers and Botox (neurotoxin).

    Restoring volume with facial fillers to the lips, philtrum, nasolabial and labiomental folds and the cheeks and “jaw line” are often necessary to produce the optimal restorative esthetic result for many denture and implant patients as well as middle-aged and senior patients who undergo routine general dental restorative treatment.

    Non-surgical treatment of a “gummy smile” is simply accomplished with a very small dose of Botox at each levator labii superioris muscle. Treatment of the damaging and painful effects of TMJ/TMD symptoms such as excessively worn dentition and damaged periodontium, derangements of the TMJ capsular components both hard and soft, muscular pain of the muscles of mastication and associated headaches, and persistent fractures of dental restorations are successfully reduced and even eliminated with the utilization of Botox treatment of the masseter and/or temporalis muscles. And of course, rhytids (wrinkles and facial “lines”) of the peri-oral draping soft tissues are reduced with Botox treatment. Botox and facial filler treatments are temporary due to the nature of their physiologic properties.

    How much daily familiarity do gynecologists and internists have regarding head and neck anatomy? How much training and experience in creating beauty, balance and proportion do they receive? How familiar are these doctors in effectively anesthetizing the facial region on a customary basis? In there daily practice routines, how concerned with the cosmetic appearance of their patients are these estimable physicians? Yet, by mere possession of their medical licenses, they are deemed suitable and appropriate to provide Botox and facial filler treatments to their patients and with no additional training requirements necessary.

    General dentists are very knowledgeable in head and neck anatomy and are accomplished and adept in surgical and non-surgical procedures. They possess exceptional skills to achieve an excellent cosmetic and restorative result by virtue of training and a highly developed appreciation and sense of beauty, balance and proportion. Attending to the enhancement and treatment of the peri-oral soft tissues is well within the domain of the general dentist. The properly trained general dentist is very well-suited to become an expert facial rejuvenation practitioner.

  9. That is a really interesting concept and one which could work well. If your brain thinks you are happier this could make you feel better. Plus you have the added benefit of looker younger which could also have an impact on your self esteem which could improve your moods.

  10. Of course too much botox is not good. Yes, botox can make people happy and stress-free. Thank you for blogging this!

  11. actually, a recent double blind placebo controlled study showed that 60 percent of those treated with botox had effective relief from depression compared to 16% of placebo treated patients. This was determined via HAM-D scores. n=30 so it was a small trial but hopeful. the theory is based on a few classic studies showing that biting down on a pencil can have antidepressant effects. that’s cheaper than botox… but it looks like the data is slowly starting to appear.

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