The need for additional treatments for depression stems from the observation that only a minority of patients achieve full remission on currently available antidepressant medications, each of which has its own adverse effect profile. In the 1963 musical “Bye Bye Birdie,” Dick van Dyke sang the song “Put On a Happy Face” to Janet Leigh. Having followed Dick’s advice, Janet undergoes a prompt and readily visible transformation of her energy and mood. Well, maybe there was some substance to that advice, as suggested by this clinical trial of botulinum toxin (B-TOX).

The Facial Feedback Hypothesis suggests that when one volitionally produces a particular facial expression (e.g., frowning, smiling), concordant emotions are experienced, perhaps through some CNS feedback mechanism. So, might elimination of frown muscle tone with B-TOX improve mood?

Magid et al randomized 30 patients with depression to B-TOX vs placebo administered at baseline in the facial glabellar region frown musculature. Depression scores were measured over 24 weeks post-injection.

B-TOX was associated with a statistically significant reduction in depression scores, which persisted throughout the 24-week interval, even though the cosmetic effects on the facial frown musculature dissipated by 12-16 weeks. Reductions in depression scores on the Beck Depression Inventory were impressive: more than one-third of B-TOX recipients achieved at least a 50% reduction in depression scores. B-TOX appears to be a prompt and effective treatment for depression.