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Does Botox Improve Depressive Symptoms by Removing the Omega Sign?

January 09, 2018
Charles Raison

In this occasional feature on Psych Congress Network, members of the Psych Congress Steering Committee answer questions asked by audience members at Psych Congress meetings.

QUESTION: Do you think Botox works because it removes the “omega sign” in the forehead seen in melancholia? 

ANSWER: Current evidence provides a complicated answer to this question.

Your Questions AnsweredIt is unlikely that specifically removing this “sign” produces the antidepressant effect, because the effect far outlasts any effect of botulinum toxin A (Botox) on the face and because the effect was not associated in studies with change in facial wrinkles/lines. On the other hand, best evidence does suggest that Botox may indeed work by interrupting signals running from the face to the brain.

Most of us naively assume that we frown because we are unhappy, but multiple studies now show that when we frown that makes us feel unhappy—something known as the “facial feedback hypothesis”. Said differently, our brain seems to decide how to feel based in part on what the face is telling it. Think of the old song “smile and the world smiles with you.” Smiling (or in this case not frowning) tells the brain we must not be feeling that bad. Further evidence for this idea comes from unpublished findings that injecting Botox into smile lines around the eyes (ie “crow's feet”) makes people feel emotionally worse.

Note, however, that the idea that Botox works via changing face-to-brain signaling remains hypothetical. It is also possible that Botox works by being taken up into the brain, where it has direct actions.

— Psych Congress cochair Charles Raison, MD, the Mary Sue and Mike Shannon Chair for Healthy Minds, Children & Families and Professor, School of Human Ecology, and Professor, Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison.​


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