When it comes to wrinkles, one of the first anti-aging treatments people try is Botox. Some Botox-users report that this injectable line-smoothing treatment helps them to feel better about themselves and boosts their confidence. But this isn’t the only reason Botox has such a positive effect on mood.

Here’s the surprising story…

The injection of Botulinum toxin, better known as Botox, is a well-known cosmetic procedure that irons out facial lines and wrinkles. Because it works by paralyzing muscles, Botox has also been used successfully to treat migraines, excessive sweating, eye twitching and more.

In addition, recent studies show Botox has value in relieving emotional disorders such as anxiety and depression. The mechanism behind these effects on mood remain unknown, but doctors believe it has something do with the facial feedback hypothesis.

What Is The Facial Feedback Hypothesis? 

The facial feedback hypothesis is based on the idea that a facial expression not only expresses an emotion, but that sensory feedback from the facial action influences the emotional experience. Studies to date bear this out…

For example, a series of randomized placebo-controlled trials show Botox injections can reduce the symptoms of depression compared to saline injections. Here’s how it works: By injecting Botox into the glabellar – the area between the eyebrows where frown lines occur – you paralyze “grief muscles” that express negative emotions. Researchers believe that this disrupts signals from the face to the brain that maintain and reinforce these negative emotions.

However, these studies are suspect because the procedure relaxes the face muscles; this would be obvious to participants in the Botox group, therefore the studies can’t really be described as placebo-controlled and could have produced biased results.

More recently researchers from the U.S. and Germany joined forces to try a different approach.

Their intention was to compare patients with medical conditions where Botox was used to those who had the same conditions where more traditional treatments were used, and then assess future reports of depression among the whole cohort.

The results were encouraging…

Reduces Depression and Slashes Anxiety Attacks 

To do this, the research team analyzed a database of 40,000 people who had received Botox at various injection sites on the body for seven different medical conditions including cosmetic issues, joint and muscle pain as well as overactive bladder and spasms in the upper and lower limbs.

They found patients receiving Botox reported significantly less depression compared to patients undergoing different treatments for the same conditions. They concluded that not only could Botox be used to treat depression, confirming previous reports, but this treatment could also protect against the development of the condition.

The study demonstrates that the antidepressant effect of Botox doesn’t depend on the site of the injection or expectations of an improved appearance. The researchers believe the facial feedback hypothesis is still valid but “may act through a more complex mechanism.”

The researchers replicated the study again using the same database to analyze the effects of Botox on anxiety. They found anxiety disorders occurred between 22 and 72 percent less often in patients using Botox compared to those treated with other therapies.

Lessens Impulsive Behavior 

In the most recent study, published in the journal Scientific Reports in August, a large research group from Germany scanned the brain to see what changes occur with a Botox procedure.

This time they tested Botox on 45 women with borderline personality disorder (BPD), where sufferers experience an excess of negative emotions like anger and fear.

The researchers gave the women either a Botox injection in the glabellar, or acupuncture, and interviewed them about their emotional states before and after the treatments. Researchers also prescribed a task called “go, no go” which measured the women’s ability to stop a habitual response to different emotional facial expressions on a computer screen. During this task the researchers monitored their brain activity

After four weeks both Botox and acupuncture led to an easing of BPD symptoms, but only Botox reduced impulsive behavior in the task and increased activity in prefrontal brain areas involved with inhibitory control. In addition, the processing of negative emotional facial expressions in the Botox group was accompanied by a reduction in the activity of the amygdala, which is critically involved in the processing of negative emotions.

The study’s senior author, Dr. Axel Wollmer, who was also involved in the anxiety and depression studies, said, “Since facial expression and psychological state are closely related, relaxing the muscles also reduces the intensity of emotions.

“Treatments such as psychotherapy or antidepressants don’t work sufficiently for [one] third of the patients so there is a need to develop novel treatment options, and this is where Botox injections could have a role.”


  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7393507/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8692576/ 
  3. https://semmelweis.hu/english/2022/09/botox-not-only-smoothes-wrinkles-but-also-the-soul-first-
    imaging-evidence-in-patients-showing-it-modifies-brain-activity/ 
  4. https://www.nature.com/articles/s41598-022-17509-0 

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