Can Botox Lift Low Mood? Maybe, Research Suggests
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I was a latecomer to the Botox party. While many of my friends in their forties and fifties were getting their brows and forehead furrows smoothed, I was too chicken to join them, even as I admired their seemingly well-rested faces.
The source of my reluctance? A woman who lives on my street has such an expressionless face from too much Botox (which uses botulinum toxin, a medication for therapeutic and cosmetic purposes, per StatPearls) that she looks “frozen.” In other words, I doubt she’d be able to move the upper part of her face if she tried. I definitely didn’t want that to happen to me.
But after getting tired of viewing what I called “the trenches in my forehead” on video calls during the pandemic, I decided to take the plunge — er, the 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 had me alternately raise my brows high and frown as hard as I could as she took photos of my face. That’s when we made an interesting discovery: It turns out 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 had always thought I had an unconscious habit of making a funny face while having my photo taken because I don’t like being photographed. But it wasn’t me; it was my face, going rogue.
With some judicious Botox injections into several spots on my forehead, especially the right side, the doctor addressed this issue, as well as my “trenches.” She had me come back two weeks later for fine-tuning.
Can Botox Lift Low Mood?
Here’s the remarkable part: After my first treatment, not only did I look more relaxed, but I felt more relaxed, too. I’m prone to anxiety, and after the injections kicked in 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 toward them. My mood felt generally lighter, steadier, and more upbeat.
That’s when I began to wonder: Did some of my anxiety stem from the overactive muscle in my forehead that was making me frown or furrow my brow without realizing it? Or, was something else going on? I decided to investigate.
It turns out that research has examined the effects of botulinum toxin injections on depressed mood and social anxiety — and turned up positive results. A study published in September 2021 in Brain and Behavior found that people with depression who received botulinum toxin injections in the frown muscles and other key areas on their faces experienced a decrease in their depression comparable to those who took sertraline (Zoloft), an SSRI antidepressant, after 12 weeks. What’s more, the onset of mood improvements came earlier for people who had injections.
Previously, an uncontrolled study published in the March 2019 Journal of Neurology, Neurosurgery, and Psychiatry examined the effects of botulinum toxin injections on 715 people with chronic migraine: Over a two-year period, most of the participants experienced a reduction in their headache days, as well as their symptoms of depression and anxiety (which often accompany these debilitating headaches). While it might seem like the mood improvements stemmed from the reduction in pain frequency, the researchers noted that reductions in depressive and anxiety symptoms occurred even in people who experienced limited decreases in their headache frequency.
And a previous randomized controlled trial found that a single treatment of Botox injections into frown muscles in the forehead led to a 52 percent decrease in depression scores among people with major depressive disorder (MDD) after six weeks post treatment, but in only 15 percent in the placebo group, who received saline injections.
How the Facial Feedback Hypothesis May Play Into It
While the assumption might be that depressed people feel better because they look more relaxed after receiving these injections, that’s not entirely what’s happening. The results more likely have to do with the facial feedback hypothesis (FFH), an idea introduced by the biologist Charles Darwin in 1872 and further explored by the 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 a bidirectional one,” 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 be reflected 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 feeling,” Dr. Rosenthal explains. In short, the expressions you make on your face influence your thoughts and feelings.
By paralyzing key muscles in the brow and forehead, botulinum toxin injections make it nearly impossible to frown. As a result, it’s believed that the face can’t send signals of anger, sadness, anxiety, or other negative emotions to the brain, so the mind starts feeling better and depression eases.
The Indirect Effect of Botox for Improved Mood
Interestingly, there’s even a possibility of positive ripple effects on other people. A review published in the September 2020 Journal of Cosmetic Dermatology suggests that when botulinum toxin injections soften one’s frown lines, it changes the way others respond to you — namely, by reducing their negative emotions. “Your expressions and moods have repercussions for those around you,” explains the lead author, Mark Nestor, MD, PhD, the director of the Center for Clinical Cosmetic Research in Aventura, Florida, and a professor of dermatology and cutaneous surgery at the University of Miami Miller School of Medicine in Florida. This effect relates to “the theory of embodied emotions — the idea that social interactions have to do with emotional contagion,” Dr. Nestor explains. “When you’re around people who are frowning, you feel bad.” By contrast, when you’re with people who look relaxed, you may feel more relaxed, too.
When I mentioned my experience to my cosmetic dermatologist, she fully believed it. So did Rosenthal. “I am not surprised that Botox helped your anxiety,” he says. “Although there are no controlled studies showing that effect, anecdotal evidence like yours and theoretical reasons suggest that it is possible if not probable.”
Who knows? Maybe my family will end up feeling more relaxed, too.
Most people aren’t getting Botox injections to improve their mood — but they may get that result as an unexpected perk, like I did. Don’t get me wrong: I don’t feel happy all the time now. I still get worried or stressed, but the intensity of these feelings has lessened substantially. And though some research shows a link between botulinum toxin treatments and improved mental health symptoms, the U.S. Food and Drug Administration (FDA) has not approved Botox, or any other facial injectable brand, 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, the treatment lasts a matter of three to four months, though some people may need injections less frequently as time goes by, according to the American Academy of Dermatology (AAD). And because facial injectables are not approved by the FDA for the treatment of mental health conditions, you should always consult your mental health care provider for proper evaluation and more evidence-supported approaches to address serious mental health concerns.
From my own experience, I do know that I felt lighter and brighter after Botox, but managing my emotional well-being is something I continue to work on in various ways, including exercising regularly and practicing mindfulness and gratitude. “Feeling better is a self-perpetuating state,” Rosenthal says. “It propels people to do positive things for themselves — they may become motivated to meditate, exercise, or become more social, for example.” Any of these can have a positive effect on your emotional well-being.
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