Synopsis:  Many people are familiar with the use of Botox to reduce wrinkles and frown lines. But Botox can also be used to reduce the effects of depression. One of the principal researchers on this subject explains.

Host: Nancy Benson. Guest: Dr. Eric Finzi, dermatologic surgeon, Washington, DC and author, The Face of Emotion: How Botox Affects Mood and Relationships

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 Botox and Depression

Nancy Benson: Depressed people don’t smile a whole lot, and that makes sense, right? Who wants to smile when you feel sad or depressed? But new research shows you may feel blue because you’re frowning not the other way around.

Eric Finzi: The expressions on our face help drive the emotions and it’s not just that oh yes now I’m feeling a certain way sad so yes I’m going to express it. No, it’s a circular thing. Everything feeds back to the brain, and it’s hard to feel an emotion unless you act it out whether it be on your face or with your body or your voice emotions aren’t sort of just floating around there in a brain in some ether they have to be in body.

Nancy Benson: That’s Dr. Eric Finzi a dermatologic surgeon in Washington D.C and author of The Face Of Emotion How Botox Effects Moods And Relationships. The book is an outgrowth of Finzi’s two studies showing that people with depression improve, often markedly when their frown muscles are frozen with Botox. In fact nearly a quarter of Botox recipients in the studies experienced complete remission of depression. So Finzi says that brings up a chicken and egg question: what comes first, emotion or its corresponding facial expression.

Eric Finzi: The way to look at it is that facial expressions have co-evolved with our emotions, over millions of years so their intimately connected to our emotions and they can help generate the emotions. There’s actually a lot of evidence to show that to do a simple thing like smile, you’ll actually evaluate the short story your reading more positively. Conversely if you frown while your looking at some picture of a famous celebrity, you’ll think their less famous you’ll have a more negative view on the world around you if you just happen to be frowning. And the other key point is that most of this is occurring in our emotional unconscious, so what you are aware of, your emotional conscious, is just a very small part of what’s happening inside your brain at any time.

Nancy Benson: Finzi’s studies of been replicated with similar results in Switzerland and Germany, but what you might find surprising is the site of the Botox injection. Most people associate sadness with a frowning mouth but that’s not the muscle that’s frozen with Botox.

Eric Finzi: The Injections for all the studies to date they’ve all been done between the eyebrows, so that’s the primary muscle of frowning is between the eyebrows. If you look at facial expressions, the negative emotions anger, fear and sadness, are all represented in contraction in this muscle between the eyebrows. So, any one of those usually will involve that muscle. When you look at somebody who’s muscle is really contracting up there, that just sends a signal to your unconscious brain that something’s not quite right, and it gets you a little bit perturbed a little bit upset as it’s supposed to, because it’s a signal from that person that maybe all is not well.

Nancy Benson: Researchers don’t know the exact mechanism that makes this work, but Finzi says “feedback loops” could explain how facial expressions can influence how you think and feel.

Eric Finzi: The way to look at any muscle in the body is that in order for you to move a muscle your brain has to send out a signal. Well, it turns out that for every signal it sends out it gets one back, because the brain needs to be aware of what is the body doing if you move your arm and lift something, your brain knows exactly where you’re hand is just as it’s lifting that glass because it’s getting a signal back from these receptors in your hand which tell it, oh, okay your hand just picked it up. So, the same thing occurs with the muscles of facial expression, and I believe that the brain sort of reads your emotional temperature. So, if you’ve been frowning all day, you’re sending signals back to your brain well maybe things aren’t so good, and if you’ve been laughing and smiling all day long, well the brain gets the signal that well I guess life has been treating you well.

Nancy Benson: Some people have wondered if the botox itself might be improving people’s mood, but finzi says there’s no evidence of that. He says the dosages used are very small—for example, 20 to 40 times smaller than the dosage used to treat Cerebral Palsy.

Eric Finzi: It’s important to remember that Botox is a drug and half of its uses around the world have nothing to do anything cosmetic, but are for medical conditions like spasms in the neck or migraine headaches or excessive sweating, Parkinson’s Disease, to Cerebral Palsy, so these are major diseases that all seem to have a window of opportunity for treatment using the muscle. And I believe that the muscles of facial expression which is somehow involved in the circuit of the brain, and what you’re doing here is your just interrupting one part of that circuit, and so that pathway then gets stamped down, and if you happen to have too much of the negative emotional pathway you’re going to quiet that down a bit that down a bit with the Botox.

Nancy Benson: But what do depressed patients you’ve undergone this treatment say.

Eric Finzi: Here’s one patient who give’s her account she says “my reaction was not dramatic and it was not overnight. I went and did the follow-up I took the same diagnostic that I take at the outside of the study and I was amazed at the difference in my scores. It was dramatic improvement. The reality is I was feeling lighter.” It’s almost like when you carry around a weight for a long time you don’t consciously realize your carrying a weight until you set it down and you feel lighter.”

Nancy Benson: Finzi says our facial expressions can impact other people just as profoundly. He relates the story of a husband and wife stuck in a negative emotional cycle. The wife was not depressed, but had what Finzi calls an “agile frown.” The husband’s constant assumption she was angry with him prompted hundreds of arguments. But a Botox injection changed all that. When the wife insisted, “no, I’m not angry,” the husband began to believe her, and they got along much better.

Eric Finzi: It was a remarkable thing to realize that a simple change in one facial expression could actually affect how two people get a long with each other.

Nancy Benson: All of us get into a blue funk now and then and may feel stuck in a bad mood for a day or so. It’s probably not practical to get a Botox injection at times like that. But maybe, all we have to do is soften our facial expressions, unfurrow our brows and try a tentative smile. The world just might seem like a happier, friendlier place. Our writer this week is Polly Hansen. Our production director is Sean Waldron. I’m Nancy Benson.


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