Botox for your troubles?

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We’ve all heard the “money can’t buy happiness, but it can buy Botox and that’s the same thing” type of jokes, but is there more truth to the joke than meets the eye? Ongoing studies at various reputable institutions appear to show a strong link between using Botox and a decrease in depression, so can money buy you happiness after all?

The first important thing to note is that the opposite of depression is not really happiness, but rather the absence of depression. What this means is that if you are not clinically depressed, you are not going to feel happier from using Botox. What you may note, depression-sufferer or not, is that there may be a subtle difference in your interactions with other people after having used Botox.

The thinking behind the Botox for Depression theory is 2-fold. The first is that your emotions are only thoughts until you express them on your face, when they become expressions. If you are unable to express your negative emotions by furrowing your brow your thoughts of sadness never become as strong as they would be if you could. This theory is called the “facial feedback hypothesis” and it says that whatever you do with your face transmits feeling back to your brain. The second is that if you frown at people they tend to mirror your expression, and to avoid contact with you because your face is telling them you are feeling negative toward them. Unfortunately many of us frown constantly because our muscle have become trained to do so from constantly squinting at our computer screens, or from concentrating too hard, or simply from sun damage and unfortunate genetics. Once we stop frowning all the time by having little Botox injection, our faces become more friendly and approachable, and people will mirror this expression, making us feel more accepted and giving us a better sense of fitting in in our community.

In 2003 American Dermatologist Dr Eric Finzi pioneered the first study that could accurately test the facial feedback hypothesis using Botox. He started by injecting a small sample of depressed patients with Botox and found that 9 out of 10 patients reported a complete remission of their depression! Next, he conducted a double blind and randomized (meaning that both the doctor AND the patient do not know what they were treated with, and the method of choosing who gets treated with what are completely random) trial whereby half the patients (who were clinically depressed) received a single Botox injection, and the other half received a saline injection, which is obviously a placebo. The results showed a 47% reduction in scores on the Montgomery-Asberg Depression Rating scale in the patients treated with Botox, while the saline-treated patients had a reduction of 20,6% on the same scale.

A second similar trial was conducted in New York by 3 doctors who adopted the same methods: a single Botox injection vs a saline injection in depressed patients. Their study too found a 47.1% decrease in depression 6 weeks after the Botox treatment, and a 9.2% decrease in depression symptoms in the placebo group. These findings have since been repeated in 2 other studies of larger and larger sample sizes.

The evidence supporting Botox being a useful tool in alleviating depression appears to become more and more compelling with each study done, and in the 10 years since Finzi’s first study there have been multiple studies all almost unanimously finding that Botox does cause a decrease in depression.

On the flip side of this, some patients report feeling discomfort because they feel they cannot express empathy adequately, and that their joy as well as their sadness feels numbed. This is why it is so important to find a doctor that can objectively look at the way you use your face to express yourself, and ensure that they do not erase all expression from your face. For example, if you have wrinkles going horizontally across your brow they are either there because in expressing yourself you tend to raise your brows a lot, or because you have excess skin beneath your eyebrows that you are keeping out of your eyes by subconsciously raising your brow. In both of these cases paralyzing your brow completely at your first treatment with Botox would be a mistake. The patient who expresses themselves by raising their brow may feel like their Botox is very obvious, and that they can no longer look as happy, nor feel as happy as they could before. The patient with the excess eye skin will find that the skin hanging into their eyes will both hamper their vision and make them look half asleep all the time because they cannot lift the skin out of their eyes using their brow.

As it currently stands, Botox is not a treatment for depression that is covered by medical aid in South Africa, but any doctor who regularly injects Botox will be able to provide a treatment that may help you if you do suffer from depression. This is not the tretment of choice for all people, nor does it work for everyone (most of the studies report improvement in symptoms in between 45 and 60% of patients, so between 55 and 40% are not positively affected…but they don’t have wrinkles now, maybe that helps?)

If you would like to give this treatment a try make an appointment by calling (021) 6833048 ext 1, or sending us an email on You can also check out our website at


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