Botox for Depression? Behind the Science

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Botox for Depression? Behind the Science

Published by

L Andrews

on

February 10, 2025

Written with love by Lacey Andrews, Psychologist and Science Writer

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First developed in an attempt to treat the eye condition strabismus in the 1970s, Botulinum toxin – or “Botox”- has been commonly used as an anti wrinkle treatment for decades. And more recently, there has been growing scientific interest of the impact of anti wrinkle injections on mental health, particularly their effects on symptoms of Depression.

STOP!

Before continuing please remember that anti wrinkle injections are a medical procedure. Please consult with your Doctor before getting anti wrinkle injections, or if you have any questions or concerns about your mental health. See our blog disclaimer for more information or click here if you need mental health support now.

In this blog:

What is Botulinum toxin?
Anti wrinkle injections in some detail
The earliest peer reviewed study (I could find): Treatment of depression with botulinum toxin A: a case series
Studying the treatment of Depression with Botox in 2024
Does Botox treat Depression?
I need mental health support now

What is Botulism toxin?

Individual letters made of cardboard spelling "What" on a pink and orange background.

Botulinum toxin – or Clostridium botulinum – can kill you. If you breathe it in, ingest it or your wound is contaminated with it your nerves can become paralysed, and you will not be able to breathe properly, if at all. It is what the medical and scientific community refer to as a neurotoxin. Interestingly, its ability to paralyse the muscles is the very reason it is so popular on the cosmetic medicine scene.

Anti wrinkle injections in some detail

Three empty botox syringes on a yellow background.

Anti wrinkle injections are made with Botulinum toxin under appropriate conditions as regulated by the Therapeutic Goods Association in Australia. So no, you cannot just make your own anti wrinkle injections at home. You may also know all anti wrinkle injections as “Botox” – however this is a brand name, there are several brands of anti wrinkle injections that are Botulinum toxin based. In Australia, anti wrinkle injections need to be administered to you by an appropriately qualified health professional such as Dentist, Doctor or Registered Nurse. To check if someone is appropriately qualified you can always check the Australian Health Practitioner Regulation Agency “AHPRA” website here.

Anti wrinkle injections work by relaxing the muscles that cause wrinkles by blocking certain chemical signals from the nerves. If the muscles are inhibited from moving, the wrinkles are less able to deepen, or even form in the first place.

The earliest peer reviewed study (I could find): Treatment of depression with botulinum toxin A: a case series

University lecturer and her student looking at results of a study.

Okay, some of you may not know what a peer reviewed study is, so I will explain it briefly here (aren’t you lucky). For a study, or other type of research, to be published in an academic journal it needs to be peer reviewed first. But who is the “peer” who is doing the reviewing? It is someone, or usually someones, selected by the Editor of the journal who are appropriately qualified to understand what the study or research is actually about. They may also judge the importance of the study or research, and they make sure the study or research has been conducted in a scientific manner (so basically not just made up, or done so poorly the results of the study are meaningless). Often, this peer has a PhD and relevant experience to distinguish them in their field.

Now onto the the study entitled “Treatment of depression with botulinum toxin A: a Case series” by Eric Finzi & Erika Wasserman, published in 2006 in the Dermatologic Surgery journal. As it has made its to being published we may assume it has passed muster scientifically, however it is usually a really good idea to read the article yourself.

Even at a cursory glance, there are some limitations to the study. It has a small sample size of 10 participants, which can impact the reliability (can the results be replicated i.e. if we do the study again will we get the same results?) and validity (is the study actually measuring what it is claiming to measure) of the results. It also does not seem to have a control group – a group of participants who have not received the injections, or have received a placebo. Basically, there is no other group to compare to.

And (I know the Psychologists reading this are dying for me to point this out) the study is a Case series. What does this mean? Well, firstly it is unsurprising that there is no control group as this article has gotten data from case reports – a case report is about an individual who has experienced something novel or unexpected.

So why has this study made it into the journal? Well, I can’t be sure of course, I have not spoken to the Editor, nor can I read minds. However, as a Psychologist, I can see the potential importance of a study like this. Depression affects at least hundreds of thousands of Australians a year, so such a novel and reasonably accessible intervention such as anti wrinkle injections to reduce the symptoms of Depression could be life changing, assuming it is effective.

Studying the treatment of Depression with Botox in 2024

Female Botox scientist looks through a microscope.

When I first chucked the search terms “botox depression” into Google Scholar and searched articles published since 2024 multiple research articles popped up, including:

I have chosen to write about Comparing the effectiveness of 2 different doses of Botox for mild to moderate depression – which found that there was a significant improvement in depression and anxiety symptoms for both doses, however there was not difference between the groups. However I encourage you to read the other studies – they are quite interesting!

Even at first glance, the study seems more robust scientifically speaking for a few different reasons – one, that it has more than 10 participants (it has 140 initially, and by the end of the study it has 122 – they didn’t die, they dropped out of the study), and it is not a Case series – it is a Randomised Controlled Trial. In this study, this means that people were randomly allocated to either the group that got 50 units of Botox or the group that got 100 units of Botox. But why is this “better”? Well…

When a trial (a scientific study) is randomised controlled this means that outside variables that may impact the results of the study can be much better accounted for, and potentially even eliminated. For example, what if something like wearing hats could impact how Botox impacts Depression? Lets say what if people who wore hats did not have any change in their Depression measures after the administration of Botox? If we did not properly randomise participants, and the 100 units of Botox group was exclusively composed of people who wore hats, then the results would show that 100 units of Botox was completely ineffective, when this may not be the case for everyone, only for those who wore hats!

However, even there are some elements of this article that are more scientifically robust, it still has its issues, including:

The participants were all diagnosed at the Department of Neurology of the Second Affiliated Hospital of Soochow University from September 2020 to September 2021 – what if there is someone special about this group that impacts their response to Botox? The “fix” for this would be to source participants who had been diagnosed in different locations
140 participants is better than 10, however more would certainly be better
The study also discusses impacts of Botox on anxiety – why was this not mentioned in the title of the article?
Although this is Randomised Controlled Trial, it is not a Double-Blind Randomised Controlled Trial – a Double-Blind Trial means that the people administering the Botox would not know how much they were administering. There is more risk of bias when the trial is not double blind, however I can see why it may not be for safety or ethical reasons (would you like someone to inject Botox into your face when they did not know the dosage? I know I wouldn’t)
There is also no control group or groups – so people who had Depression and were administered a “placebo” (so basically they would be still be injected, just that it would not be with Botox, it would be with something else that had no impact) – again, I can see why this may not have been possible for safety reasons, and also practical ones. The control group would probably know that they were the control group (which defeats the purpose) because their muscles would still have movement!

Still, even with its limitations, it is an interesting study – as above, the study found that there was a significant improvement in depression and anxiety symptoms for both doses of Botox, however there was no difference between the groups – in other words according to this study 100 units of Botox is not more effective than 50 units. I wonder what implications this would have in future if Botox was an approved treatment for Depression? It’s potentially cost saving to say the least!

So what’s the verdict? Does Botox treat Depression?

Woman thinking about getting botox to treat her Depression.

Well firstly, I think exercising a degree of caution when someone tries to sell you a “treatment” or a “cure” is usually the wisest thing to do. And really, my answer to this question is I don’t know. Not very satisfying, eh? I mean, I would like to be sure, I would love to say YES! as I think this type of treatment could alleviate a lot of suffering. However I ethically, and probably legally, cannot make this claim based on the current evidence, and treatment guidelines for Depression.

BUT…. what I can say is Botox – botulism toxin type A – certainly seems to have piqued the interest of the scientific community. They would not have made the effort to study it otherwise! If you are interested in Botox as a treatment for Depression read the science, and watch this space.

Thank you so much for reading, I hope you found this article interesting and helpful 🖤 If so, and if you are a Psychologist or Provisional Psychologist, click here to subscribe for more free content, resources and exclusive offers!

I need mental health support now

Blackboard with work SUPPORT written on it with white chalk.

Thank you for reading this blog post, I hope you have found it useful. However I recognise that some of the content may have been upsetting, that’s totally natural. If you need mental health support now you are able to access these services:

Lifeline, call 13 11 14, text 0477 13 11 14 or chat online if in crisis.

And for people up to 25 years old, you have the option to access the Kids Helpline on 1800 55 1800 and via chat.

And for a comprehensive list of mental health services click here.