| DEPRESSION | OPINION
PARADOX’: IS IT EFFECTIVE FOR DEPRESSION?
THE ‘BOTOX
Patrick Treacy considers the conflicting evidence of botulinum toxin use as a therapy for depression, and proposes that it all comes down to where the toxin is injected
A
RECENT ARTICLE by Claire Coleman1
,
published in the UK’s Daily Mail newspaper, has led to much confusion
with regard to the role of BOTOX® in treating or causing depression. The article was based on a study led by Dr Michael Lewis of the School of Psychology, Cardiff, Wales, who followed 25 people who had received BOTOX treatment for facial lines and examined the idea of facial feedback — where the expressions we make with our faces affect how we feel — and found that many women who have the treatment for cosmetic purposes feel depressed because they are no longer able to smile properly. Previous studies, however, have
found that the treatment of frown lines left patients feeling less depressed. In 2006, Dr Eric Finzi and Dr Erika Wasserman reported in Dermatologic Surgery that treating clinically depressed patients with BOTOX on their frown lines actually reduced patients’ feelings of depression2
. Depression affects over
120 million people globally, making it one of the leading causes of disability in the world. Although there are a number of effective treatments,
therapeutic response remains unsatisfactory and depression can develop into a chronic condition in a considerable proportion of patients. An economic treatment option that could provide long intervals between treatments, and that is safe, would be very important to doctors. So, what is the truth? Is there an actual physiological reason to explain the different results?
The ‘grief’ muscles The story begins in 1872, when Charles Darwin recognised that negative emotions, such as anger, fear, and sadness — all prevalent in depression — are associated with hyperactivity of the corrugator and procerus muscles in the glabellar region of the face. Darwin called them the ‘grief muscles’ and formulated a new theory, known as the ‘facial feedback hypothesis’, which implied a mutual interaction between emotions and facial muscle activity. He published his new theory in The Expression of the Emotions in Man and Animals, which concerns the genetically determined aspects of behaviour. In this book, Darwin aimed to trace
the animal origins of human characteristics, such as the tightening of the muscles around the
eyes in anger and efforts of memory. Darwin even sought out the opinions of eminent British psychiatrists in preparation of the book, which forms Darwin’s main contribution to psychology. His theory implied a mutual interaction between emotions and facial muscle activity. Research into this stayed there during the great upheavals of both World Wars, until the rising popularity of BOTOX made scientists review his facial hypothesis. In 2003, Heckmann et al3
published data suggesting that treatment of the glabellar region with botulinum toxin could produce a change in facial expression from angry, sad, and fearful to happy, and that this could impact on emotional experience. Many therapists argue that patients who had been treated in the glabellar area reported an increase in emotional wellbeing and reduced levels of fear and sadness beyond what would be expected from the cosmetic benefit alone. In 1992, Larsen et al4
provided
evidence that voluntary contraction of facial muscles could channel emotions, which were conversely expressed by activation of these muscles. Hennenlotter et al5
went
one stage further and showed that botulinum toxin treatment to the
prime-journal.com | June 2013 ❚
PATRICK TREACY is Medical Director of Ailesbury Clinics Ltd and Ailesbury Hair Clinics Ltd; Chairman of the Irish Association of Cosmetic Doctors and Irish Regional Representative of the British Association of Cosmetic Doctors; European Medical Advisor to Network Lipolysis and the UK’s largest cosmetic website Consulti,ng Rooms. He practices cosmetic medicine in his clinics in Dublin, Cork, London and the Middle East
email:
ptreacy@gmail.com
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