Botox Appears to Ease Depression Symptoms

Of the 10 depressed patients in the Washington area whom Finzi studied, nine recovered from their depressive symptoms, and one -- who turned out to have bipolar disorder, or manic depression -- showed an improvement in mood.

Delano, a marketing director, said that by the time she got involved in the study, she had turned down so many invitations for social gatherings that people had stopped asking her. She went to see Finzi for a transient skin problem, which is when she heard he was recruiting patients for a novel treatment study of depression. He gave her two rounds of Botox injections.

"After a couple of days, the muscles in your forehead, you can't constrict them," she said. "You don't have that anxiety look. You can't furrow your brow . . . [but] for me there was not a dramatic cosmetic difference."

But where once she would hide out at home in the evenings and on weekends, Delano said, she found herself enthusiastically cheering her 8-year-old son at sports games. Her relationship with her boyfriend also improved, she said.

Finzi, who practices dermatology in Greenbelt and Chevy Chase, said his hunch was that Delano's facial muscles provided feedback to her brain.

"My theory on why this works is there is a feedback between the muscles of facial expression and the brain," said Finzi, who has applied for a patent on using Botox for depression. "With yoga, you focus on your breathing, and it has an effect on your mind. My hypothesis is the facial muscles . . . have an effect on depression."

The theory is similar to one proposed by Robert Zajonc, a psychologist at Stanford University, who thinks facial muscles may alter the temperature of blood flowing in the brain. Relaxation techniques such as yoga and tai chi may help cool the brain and result in a more positive mood, Zajonc said.

Whatever the mechanism, moods can clearly be influenced by expressions, not just the other way around, said Paul Ekman, emeritus professor of psychology at the University of California at San Francisco, who has spent decades exploring the connection between emotions and expressions.

"If you make a facial expression voluntarily, you can change the autonomic and central nervous system to generate that emotion," he said.

But Ekman said the relationship between emotions and expressions is probably too complex to explain Finzi's finding. It is unlikely, he said, that simply altering one's expressions can relieve depression.

More plausible, Ekman said, is that changing expressions can help heighten or decrease emotional states. Or it is possible that by frowning less, patients in Finzi's study seemed less forbidding to others, which helped to strengthen their social connections. In turn, that may have helped ease the depression, Ekman said.

Even depressed people who do not believe they frown all the time could seem forbidding to others, Ekman said: People rarely see themselves as others see them. And although misery may love company, the reverse is not true.

"We don't like to talk to people who are frowning all the time or who are looking in anguish," Ekman said.