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  • Chapter 26 - Treatment of Depression with Botulinum Toxin

  • Edited by Daniel Truong, University of California, Riverside, Dirk Dressler, Hannover Medical School, Mark Hallett, National Institutes of Health (NIH), Christopher Zachary, University of California, Irvine, Mayank Pathak, Truong Neuroscience Institute
  • Book:
    Manual of Botulinum Toxin Therapy
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 218-222

  • Summary

    The glabellar region of the face harbors the so called grief muscles (corrugator and procerus muscles). Combined contraction of the corrugator muscle and the medial part of the frontalis muscle account for facial features of emotional distress like the ’omega melancholicum’ or Veraguth’s folds and can be observed frequently in patients suffering from mental disorders including depression.

    According to the facial feedback hypothesis, the facial expression of emotions generates proprioceptive feedback signals that can maintain and reinforce the expressed emotions. Relaxation of glabellar muscles by means of botulinum toxin (BoNT) injections may not only give the face a less negative and more positive expression, but may also interrupt the described feedback loop and thereby lead to a less negative and more positive emotional state.

    This chapter summarizes the studies showing the effect of BoNT treatment on depression, illustrates the pertinent facial expressions and the underlying muscles that produce grief expression and shows the recommended injection sites along with dose recommendations.