Dr. Saber’s Blog

Does Botox Help Depression? Clinical Trials Indicate Yes!

IMPORTANT NOTE: Let me take a moment to remind you that I am not a psychiatrist, and I do not use Botox to treat depression (because I, of course, do not treat depression). 

But I do use Botox a lot in my practice, and it is exceedingly important that I keep abreast of all the potential side effects of its use. That way I can fully inform my patients about the pros and cons of every procedure I perform. I personally find this news about Botox to be fascinating as well as promising, so I wanted to share it with you.

What is Botox?

Botulinum toxin a (commonly known as Botox) is a toxic substance derived from spores of the bacteria Clostridium botulinum. That bacterium is found in some clay sediments as well as in the intestinal tracts of some animals and fish.

Botox, as presently formulated and used, beneficially paralyzes and/or weakens the human muscle groups into which it is injected.

Woman receiving Botox injection in forehead

During its relatively brief history, Botox (botulinum toxin a) has earned a well-deserved reputation as the Swiss army knife of medications. The New York Times recently called it “medicine’s answer to duct tape.”

Botox is currently used as an effective treatment for (at least) the following conditions:

  • Chronic migraine headaches
  • Spasticity (when a muscle spasms and then remains involuntarily contracted)
  • Neck muscle disorders
  • Blepharospasm (when an eyelid remains involuntarily closed)
  • Hyperhidrosis, i.e., excessive sweating
  • Drooling
  • An overactive bladder, i.e., bladder incontinence
  • Cosmetic use, such as erasing frown lines and facial wrinkles

But who would have ever thought that it could be a tool in psychiatry?

What qualifies as Depression?

We all have down days, and it’s hard to find anyone in our Covid-19 afflicted world who doesn’t have an occasional bout with depression. But the condition known to mental health professionals as clinical depression or major depressive disorder (MDD) is something else entirely.

The National Institute of Mental Health defines depression as “a common but serious mood disorder. It causes serious symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working.”

In 2017 (the latest year for which the NIMH provides statistics), an estimated 17.3 million adults in the United States had at least one episode of major depression. This number represents 7.1% of all US adults. The prevalence of major depressive disorder was higher among adult females (8.7%) compared to males (5.3%).

If you have been experiencing some of the following signs and symptoms of depression most of the day, nearly every day, for at least two weeks, you may be suffering from depression:

  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness or pessimism
  • Irritability
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy or fatigue
  • Moving or talking more slowly
  • Feeling restless or having trouble sitting still
  • Difficulty concentrating, remembering, or making decisions
  • Difficulty sleeping, early-morning awakening, or oversleeping
  • Appetite and/or weight changes
  • Thoughts of death or suicide, or suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment 

…the makers of Botox recently announced plans for the final phase of testing it as a treatment for depression.

Botox as an antidepressant? Early clinical trials are positive.

The currently available treatments for Major Depressive Disorder (also called MDD) don’t work for everyone. They are not effective for nearly 1/3 of the patients and often come with (sometimes unpleasant) side effects.

This has led clinicians to explore other therapeutic options, such as electroconvulsive therapy, transcranial magnetic stimulation, ketamine infusions, and, more recently, Botox injections.

In 2006 a small trial (only 10 participants) studied subjects with depression. They were all given injections in their glabella facial muscles (just below their frown lines). Two months after the injections, nine of the participants no longer had symptoms of depression. The 10th participant still had some symptoms but reported an improved mood.

In 2012, another small study followed the lead of the 2006 trial by studying 30 depressed people who were receiving standard antidepressant treatment. Half got Botox, the other half a placebo of saline.

Over 16 weeks, the patients who received the Botox injections reported a 47.1% decrease in their depressive symptoms six weeks after a single injection. (The placebo group also reported wellness improvement, but only a 9.3% symptom reduction.)

Between 2003 and 2017, a few other small and limited clinical trials looked at the efficacy of Botox for depression. Each had some notable limitations, but they continued to find that a single injection of Botox seemed to produce significant decreases in symptoms of depression.

The big clinical study: University of California San Diego

The earlier studies we discussed were limited and small. But in 2020, Dr. Ruben Abagyan led a major study. University of California San Diego researchers looked at over 40,000 reports documenting adverse effects of various medical procedures.

Progression of facial changes after receiving Botox

The US Food and Drug Administration (FDA) maintains an Adverse Event Reporting System (FAERS). This system is designed to record negative consequences from drugs and therapies by exercising a practice known as pharmacovigilance.

The UCSD researchers looked through 13 million adverse event reports concerning Botox treatments for various conditions, which included:

  • Cosmetics
  • Migraines
  • Upper and lower limb spasms and spasticity
  • Neck muscle disorders
  • Blepharospasm
  • Hyperhidrosis (excessive sweating)
  • Sialorrhea (drooling)
  • Urinary and neurological disorders

Researchers looked at the number of reported post-Botox adverse events involving depression for these various conditions. Then, they looked at the number of post-treatment depressive episodes reported after non-Botox treatment of these same conditions.

What did the UCSD team discover about the antidepressant effect of Botox?

Simply put, the UCSD team found that for six of the eight conditions, depression was reported 40% to 88% less often by the Botox-treated patients, as compared to the patients who were treated for the same conditions without Botox.

The UCSD study showed that Botox recipients that reported a reduction in depression symptoms did so regardless of where they received the injection.

How does Botox fight depression?

There are several theories and plenty of adherents for each of them. The early theories revolved around the important role our facial expressions play in our emotional lives.

Known as the “facial feedback hypothesis”, it holds that expressive behavior can alter emotional states. In other words, your feelings will follow your face. A genuine and sincere smile will prompt your emotions to conform to your outward appearance.

But there are other muscles that are activated in the presence of negative emotions, such as fear, anger, grief, etc. These are known as the corrugator muscles and are located in the glabellar region, right between the eyebrows, which is ground zero for frowning.

It seems intuitively correct (and several scientific studies confirm) that depressed people have overdeveloped and overreactive corrugator muscles.

So, if the “facial feedback” hypothesis has merit, it follows that the disabling effect that a Botox injection has on the corrugator muscles will make it difficult to facially express negative emotions.

In other words, if you don’t look unhappy, you don’t feel unhappy.

Another theory the researchers put forward is that chronic conditions can contribute to depression. So, successfully treating the underlying problem through Botox may indirectly relieve depressive symptoms.

Does injecting Botox anywhere in your body help with depression?

Man receiving Botox injection in underarm

The new study at the University of California San Diego in 2020 was different. It recorded patients’ conditions after receiving Botox injections in multiple parts of the body, not just the forehead.

For example, injecting Botox directly into spastic limbs to treat spasticity, in the underarm region and palms to treat excessive sweating, or in neck muscles to help patients with Parkinson’s disease.

What did they discover? The UCSD study showed that Botox recipients that reported a reduction in depression symptoms did so regardless of where they received the injection.

The future of Botox for depression

The data used in this study wasn’t collected specifically to explore the connection between Botox and depression. In addition, the FAERS data only represents those who reported negative side effects. The research team excluded reports in which the patient was also taking antidepressants.

However, these results are very promising. And the makers of Botox recently announced plans for the final phase of testing it as a treatment for depression.

It will be very interesting to see the results of the several larger-scale peer-reviewed trials that are currently in progress. So, watch our blog for more information about this when we learn about it.

Why Saber Plastic Surgery?

Dr. Sepideh Saber, MD, FACS is an American Board of Plastic Surgery-certified Los Angeles plastic surgeon.

She graduated from Stanford University’s world-renowned medical school and did her plastic surgery residency at the University of Southern California (USC). She then completed a fellowship at New York University (NYU) in the extremely challenging and delicate area of hand surgery as well as microsurgery.

Dr. Saber offers a more sensitive, female perspective for patients of all ages, genders, and orientations. Former patients of all ages and from all walks of life have praised not only their outcomes but her caring, thoughtful approach to all types of appearance and health-related matters.

To request a consultation, call 818-818-2939 or schedule a consultation online.

Dr. Saber takes her patients’ safety very seriously. Her facility’s Covid-19 patient safety procedures exceed all CDC and World Health Organization recommendations. Masks are required in our office at all times during the coronavirus pandemic.

The practice of Dr. Saber is located in Encino, CA for patients throughout the Los Angeles area. We are also convenient to Encino, Woodland Hills, Sherman Oaks, Calabasas, Burbank, Glendale, Hidden Hills, Agoura Hills, Northridge, North Hollywood, Malibu, Topanga, Canoga Park, Reseda, Valley Glen, Chatsworth, West Hills, Winnetka, Universal City, Bel Air, Beverly Hills, Downtown Los Angeles, Silverlake, and Echo Park.

Sources

Finzi E, Wasserman E. (2006). Treatment of depression with botulinum toxin A: a case series. Dermatol Surg, 32 ( 5…
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563881/

Postmarketing safety surveillance data reveals antidepressant effects of botulinum toxin across various indications and injection sites | Scientific Reports
https://www.nature.com/articles/s41598-020-69773-7

Dr. Saber graduated from Stanford University’s world-renowned medical school and did her plastic and reconstructive surgery residency at the equally lauded University of Southern California. She then completed a fellowship at New York University in the extremely challenging and delicate disciplines of hand surgery and microsurgery.

Dr. Saber offers a more sensitive, female perspective for patients of all ages, genders, and orientations. Former patients from all walks of life have praised not only their treatment outcomes but her caring, thoughtful approach to a wide array of appearance and health-related matters.
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    Dr. Sepideh Saber, MD, FACS

    👩🏻‍⚕️ Board Certified Plastic Surgeon
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She is only 2 weeks Post-Op and her results already look amazing!

To set up a complimentary consultation 

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We are absolutely thrilled with our patients results. ✨

Give us a call to set up a complimentary consultation with #DrSaber who will create a customized plan for you!

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    ✨ Our lovely patient came in for our Bilateral Breast Reduction procedure✨

The procedure gave her tremendous relief of back pain, neck and shoulder pain, bra strap grooving, and rashes under her breast folds. Our patient also feels much more comfortable wearing any type of clothes she likes. 

Give us a call to set up a complimentary consultation with #DrSaber who will create a customized plan for you!
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    ✨ Our patient is 4 weeks post Tummy Tuck and Breast Reduction.

Her scars are a bit fresh. Overtime they will heal and become less visible. ✨

Give us a call to set up a complimentary consultation with #DrSaber who will create a customized plan for you!
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    Thank you for the beautiful review and recommendations. I always strive to create a safe and calm experience for my patients, so glad you're pleased with your treatment. ❤️ 

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  • What patients say about Dr. Saber

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    I was fortunate to find Dr. Saber after researching board-certified surgeons who specialize in breast cancer reconstruction revision surgery. I knew I was in good hands from the moment I spoke with the lovely and efficient Marlene, Dr Saber's office manager. Dr Saber patiently listened to my concerns and, after examining me, explained what I could realistically expect the outcome to be from another surgery. She also explained to me that she would need to review my previous surgery notes before we could discuss a possible further surgery, which I found comforting and highly ethical. I also discussed a couple of other procedures that I would like done, including fat removal from my large upper arms that had caused me great embarrassment for several years. Dr. Saber is an excellent surgeon who is incredibly kind and genuine. She truly understands the female body and the emotional aspect of body insecurities yet, she is transparent about what can and cannot be done and takes time to discuss realistic expectations and outcomes. My breast reconstruction revision surgery will take place in the New Year, but in the meantime, I have the most fabulous upper arms that I recently flaunted in a strapless dress (something I have not done in years). Dr Saber is truly one of a kind, and I still cannot believe how fortunate I am to have found her. I highly recommend Dr Saber.

    Linda DeCarlo November 29, 2023

    I don’t have enough wonderful words to describe Dr Saber and Marlene! I had a tummy tuck done this year and from start to finish the entire experience was amazing. Marlene is always so helpful and works so hard to make every detail a breeze for you. When I had my consultation with Dr Saber I was at a point of complete agony with my body. She instantly took that stress and frustration off my shoulders! As a woman not being heard by doctors for years I left that consultation with happy tears knowing I had finally found my Dr. It was a major surgery and I felt completely zen and at peace going in because she really does make you feel that safe. I didn’t think I would ever look the way I do now! She gave me the gift of having the body I kept fighting for. I will never stop recommending her.

    Monica Prusa October 9, 2023

    I saw Dr. Saber when I broke my wrist. I ended up having to have surgery. She did an excellent job and I am healing nicely. She was very professional, but was also very kind and compassionate. I would highly recommend her!!

    Sandy Schaupp September 13, 2022

    I LOVED DR SABER!!! There are a few reasons why I chose her. One was because she’s a female Doctor that was my goal who also did a good job (which I was able to confirm with all her before and after photos) and what sold me was my safety in mind. She made me feel like I was in the best hands ever along with Marlene who coordinated everything THANK YOU LADIES! Dr Saber helped me get back the body I have always desired. I had a lot of stomach fat from weight gain and I lost weight so a lot of my weight was in my front lower and upper abdomen. Now I have a super beautiful curvy body like an hourglass after a tummy tuck and lipo she did. She understood the assignment hahaha . I’m 32 years old no kids just wanted to enjoy my younger body looking and feeling beautiful and she really took good care of me. Even after hours I had an emergency due to my fault but she was there and got back to me very quickly and I’m very grateful. I also think her work says a lot because I stopped taking pain medication on the 3rd day after surgery and was fine with very minimal pain I was able to tolerate the healing process. Highly recommend going with her I just had a wonderful experience and would do it all over again if I had too. Maybe after I have kids. Thanks Dr Saber and team <3

    STEPHANIE d July 15, 2022

    Dr.Saber is by far one of the best plastic surgeons. I love how she takes her time to explain any procedure to the patients understanding. She always makes sure to answers any and all questions.From fillers to body contours she’s the one you want.

    Katherine Melara February 15, 2022

    Dr Saber is amazing! She is caring and very informative. I went in for fillers and she explained procedure step by step. I highly recommend her and look forward to future visits.

    Amanda Vazquez December 18, 2020

    Dr. Saber was friendly, knowledgeable and professional. She took time to listen, answer all my questions and was forthright in her recommendations. Her staff was friendly and helpful. I was very happy with the results and plan on going back. If you are looking for a first rate professional experience look no further she is the doctor for you!

    T R December 18, 2020

    Dr. Saber is one of a kind plastic surgeon with a heart of gold. She is a well verse plastic surgeon that puts her patient's needs before anything else. She genuinely cares about every single patient, and her work speaks for itself. I notice every post-operative result on her Instagram (@saberplasticsurgery) the patients have this glow that radiates through. I have been going to Dr. Saber for my Botox for the past 3 years, and love the results every time. I know who I will be going to for any future plastic surgery needs, and will confidently refer family and friends to Dr. Saber for any Botox, fillers, and plastic surgery consultations.

    Rudy Garcia December 16, 2020

    I have nothing but great things to say about Dr. Saber! I am so pleased with my results from a breast augmentation she performed on me back in late June! She answered all my questions and concerns before and after my surgery. She’s very easy to get in contact with and she’s so nice. She made feel so comfortable throughout the whole process. 100/10 Lover her work!!

    Amanda Villegas October 15, 2020

    Dr Saber is hands down the best surgeon! She took her time answering my questions and explained procedure in detail. After doing liposuction six months ago, I am extremely happy with my results and I appreciate her so much.

    Marlene Cosentino October 15, 2020

    Dr. Saber is so kind and thorough with her patients! She is an amazing doctor and genuinely cars about everyone she comes in contact with. I would recommend her to anyone for any hand surgery or cosmetic procedure.

    Rachel Meach October 15, 2020