Using Botox to treat depression. Seriously.

Nearly 150 years ago, Charles Darwin recognized that facial expressions not only communicate the emotions we feel but intensify them, by sending cues back to the brain. In the ensuing decades, researchers proved again and again that we can influence the way we feel by the visage we project. Smiling can help us feel happier. Frowning can make us feel angrier.

But it was only in the past few years that a dermatologist from Chevy Chase, Md., noticed that some of the patients whose brows he temporarily paralyzed with Botox, to remove wrinkles, began to feel relief from depression. That physician, Eric Finzi, took his idea to a Georgetown Medical School psychiatrist, Norman Rosenthal, who teaches at Georgetown Medical School and had spent many years studying how light and odors, transmitted to the brain through the nerves that connect it with the eyes and nose, affect our moods.

Now there have been three small studies that show that Botox injections can help with depression. In the latest, published in the current issue of the Journal of Psychiatric Research, Finzi and Rosenthal showed that 17 of 33 patients experienced better than 50 percent reductions in their depression symptoms after a single Botox injection, and 27 percent of the group saw their depression go into remission. The study confirms a similar one reported in 2012 by German researchers Tillmann Kroger and Axel Wollmer, who spoke of their findings at a meeting of the American Psychiatric Association in New York this past weekend.

"There are several nerves, about 12 of them, that go straight into the brain through the skull," Rosenthal told me Tuesday.  "...We’re used to thinking of them in terms of their outbound messages or signals. We’re not used to thinking of them in terms of their inbound messages."

The idea holds promise as a supplement or alternative to anti-depressants and psychotherapy for treating depression, according to Rosenthal. Minuscule amounts of Botox -- which is made from the lethal botulinum toxin -- are injected into the facial muscles and don't even enter the bloodstream. The procedure has shown no side-effects.

If the whole idea seems almost too outlandish to believe -- as it did for me -- Rosenthal was quick to point out that he was laughed at 30 years ago, when he proposed the idea of "seasonal affective disorder" and the notion that exposing people to bright light in the depths of winter could help with that kind of depression.  "Now, it's ubiquitous," he said. "Then, they thought it was ridiculous."

The treatment isn't perfect. Botox is expensive, at about $400 per dose, wears off in about three months and isn't covered by insurance. And as the studies showed, it doesn't work for everyone.

But the botulinum toxin already is used to treat a wide variety of medical conditions. Perhaps depression is next.

Lenny Bernstein writes the To Your Health blog. He started as an editor on the Post’s National Desk in 2000 and has worked in Metro and Sports.
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