Can Botox Help With Depression? What the Research Really Says?
When most people hear “Botox,” they think of smoothing forehead lines, softening frown lines, and refreshing their appearance. Researchers have been looking at Botox from a very different perspective: could relaxing the muscles we use to frown also affect the way we feel?
Over the past several years, studies have explored the connection between botulinum toxin, facial expressions, and depression, particularly when Botox is injected into the glabellar area between the eyebrows. Some of the findings have been surprisingly positive, with researchers observing improvements in depressive symptoms among certain participants.
So, could something we traditionally think of as a cosmetic treatment have an effect on mood? The answer isn't as simple as you might think. Let's look at what the research actually found, what participants experienced, and why scientists are still studying this fascinating connection.
Could Your Frown Be Affecting Your Mood?
One theory behind this research is called the facial feedback hypothesis. The idea is that our facial expressions may do more than communicate emotions to others, the movement of our facial muscles may also send signals back to the brain that influence how we process emotions.
The muscles between the eyebrows, known as the glabellar muscles, are particularly interesting because they play a role in expressions we make when we're worried, frustrated, angry, or upset. This led researchers to ask an interesting question: if you temporarily relax these muscles, could it change the way the brain processes those emotions?
That question eventually led to clinical studies looking at botulinum toxin injections in the glabellar area and their potential effects on depression. Importantly, this research is about a potential medical application of botulinum toxin, not about cosmetic Botox replacing antidepressants, therapy, or other established depression treatments.
What Did the Early Studies Find?
The first clinical studies looking at Botox and depression produced some pretty interesting results.
A 2015 pooled analysis combined data from three randomized controlled trials involving 134 participants. Six weeks after treatment, people who received botulinum toxin showed a much greater improvement in their depression symptoms compared with those who received a placebo. Depression scores improved by 45.7% in the Botox group, compared with 14.6% in the placebo group. The Botox group also had higher rates of both treatment response and remission.
Another randomized, double-blind, placebo-controlled study published in 2014 followed people with major depressive disorder for 24 weeks after receiving botulinum toxin A. Researchers again found improvements in depressive symptoms, adding to the growing interest in the potential connection between the glabellar muscles and mood.
These early results raised an interesting question: was relaxing the muscles between the eyebrows actually helping with depression?
That question gave researchers plenty of reason to keep investigating.
What Did the Bigger Studies Show?
As more researchers became interested in the possible connection between Botox and depression, additional studies started looking at the question from different angles.
A 2020 systematic review and meta-analysis published in Frontiers in Psychiatry looked at five randomized controlled trials involving 417 participants. Researchers found a statistically significant improvement in depressive symptoms among people who received botulinum toxin compared with placebo. The treatment was also generally well tolerated, with mostly mild and temporary side effects.
A separate 2021 meta-analysis also found greater improvement in depressive symptoms with botulinum toxin compared with placebo, although the researchers pointed out some limitations in the available studies and emphasized the need for more research.
Then, a 2022 systematic review and meta-analysis looked at nine prospective studies. All five randomized controlled trials included in the analysis reported improvements in average depression scores six weeks after treatment.
With multiple studies pointing in a similar direction, the question became even more interesting: could there really be a connection between relaxing the muscles responsible for frowning and improving mood?
The answer is still being studied, and researchers are continuing to look at factors like dosing, patient selection, placebo effects, and exactly how Botox might influence emotional processing.
Could Participants Tell They Got Botox?
This is one of the most interesting parts of the research.
In a typical clinical trial, participants are kept “blinded,” meaning they don't know whether they received the actual treatment or a placebo. With Botox, that's not always easy. Once the glabellar muscles are relaxed, participants may notice that they can't move or frown the same way they normally do.
In one early study, about 90% of participants were able to correctly guess whether they had received Botox or placebo by the end of the study, largely because of the visible cosmetic difference.
Why does that matter? Researchers have to consider expectancy effects, the possibility that knowing you received a treatment could influence how you feel or how you report your symptoms.
At the same time, the improvements seen in some studies may not be explained by expectations alone. That's one reason researchers have continued testing different study designs to better understand what is actually happening.
A New Study Took a Different Approach
A 2024 randomized study called OnaDEP, published in Depression and Anxiety, took a different approach to studying the connection between Botox and depression. Instead of comparing Botox with a saline placebo, all 58 participants received onabotulinumtoxinA. Researchers then divided them into two groups, with injections placed either in the glabellar area between the eyebrows or around the crow’s feet.
The participants knew they were receiving Botox, but they didn't know which injection area researchers expected to have an effect on depression.
Six weeks later, 44.8% of participants in the glabellar group responded to treatment, compared with 17.9% in the crow’s-feet group. The difference was statistically significant.
Why is that important? This approach helped researchers work around one of the challenges of traditional Botox-versus-placebo studies: participants can often tell when their frown muscles have been relaxed.
The results add to the idea that where Botox is injected may matter, and that the potential effects being studied may be more than simply knowing you received an injection.
What’s Actually Happening in the Brain?
Researchers are still trying to understand exactly why Botox may affect mood. One theory focuses on the way our facial muscles and brain communicate with each other.
When the muscles responsible for frowning are temporarily relaxed, they send different signals back to the brain during emotional experiences. Brain imaging research has also suggested that reducing activity in the corrugator muscles may influence areas involved in processing emotions, including the amygdala.
In simple terms, your face and brain are constantly communicating. Researchers are now exploring whether changing the way certain facial muscles move could also influence how the brain processes emotions.
This is one of the theories behind the research into Botox and depression, and scientists are continuing to study exactly how this connection works.
What About the People Who Didn't Improve?
Not every study has produced the same results, and that's an important part of understanding the research.
In one phase 2 randomized, double-blind, placebo-controlled trial, researchers tested 30-unit and 50-unit doses of onabotulinumtoxinA in adult women with depression. The 30-unit group showed improvement, while the 50-unit group did not show a significant difference from placebo on the study’s main outcome. Researchers noted that the high placebo response in the 50-unit group may have played a role.
A 2021 meta-analysis also found differences between the studies, suggesting that factors such as dose, sex, and other medications may influence the results.
These findings are a good reminder that the research is still developing. Botox has shown promising results in several studies, yet more research is needed before it can be considered an established treatment for depression.
Botox for Depression vs. Botox for Frown Lines
There’s an important distinction to make. When you visit a medical aesthetics practice for Botox in the forehead or between the eyebrows, the goal is typically cosmetic, softening lines and creating a refreshed, natural-looking appearance.
The studies on depression are different. Participants were diagnosed with major depressive disorder and received botulinum toxin as part of controlled clinical research specifically designed to study its potential effects on depression.
If you’re living with depression, Botox should not be considered a replacement for professional mental health care, medication, or therapy. The research is exploring something different: the fascinating relationship between facial muscles, the brain, and the way we process emotions.
Frequently Asked Questions
Can Botox actually treat depression?
Research suggests it may help reduce depressive symptoms in some people, particularly when injections are placed in the glabellar area. Several clinical trials have reported positive results, but the evidence is not conclusive yet. Botox is not an FDA-approved treatment for depression and should not replace therapy, medication, or other professional mental health care.
Is Botox FDA-approved for depression?
No. Botox is FDA-approved for cosmetic use and several medical conditions, but not for the treatment of depression. Its potential effects on mood are still being studied.
Where is Botox injected in the depression studies?
Most studies have focused on the glabellar area between the eyebrows, where the muscles responsible for frowning are located. This is different from other common cosmetic treatment areas, such as crow’s feet.
How does Botox potentially affect mood?
Researchers are exploring the facial feedback hypothesis, which suggests that relaxing the muscles involved in frowning may change the signals sent from the face to the brain. Scientists are particularly interested in how this may influence areas involved in emotional processing.
Should I get Botox if I have depression?
If you’re considering Botox for cosmetic reasons, it can be used to soften frown lines and other signs of facial movement. However, it should not be considered a treatment for depression. If you’re experiencing depression, speak with a qualified mental health professional about appropriate treatment options.
Where Does the Research Stand?
Research into botulinum toxin and depression has produced some interesting results. Several randomized controlled trials and meta-analyses have found improvements in depressive symptoms following injections in the glabellar area, while other studies have highlighted questions around placebo effects, dosing, and study design.
So, can Botox help with depression? The research suggests there may be a connection, but more studies are needed before Botox can be considered a standard treatment for depression.
For cosmetic Botox, the goal is much more straightforward: softening frown lines and other signs of facial movement while creating results that feel natural and personalized.
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