CNS Drugs

, Volume 32, Issue 2, pp 97–100 | Cite as

Botulinum Toxin: Does it have a Place in the Management of Depression?

  • Matthew V. Rudorfer

“‘Cause when you worry your face will frown/And that will bring everybody down/So don’t worry, be happy.” This bit of pop pathophysiology, sung by Bobby McFerrin in the 1988 Grammy Song of the Year [1], has in the past dozen years been taken quite literally in some quarters at the interface of dermatology and psychiatry. The hypothesis is that, by using targeted intramuscular injections of botulinum toxin, type A (onabotulinumtoxinA, BTX-A, Botox) to pharmacologically block frowning, and the associated muscle contractions that lead—along with age—to “worry lines” and facial wrinkles, depression could actually be treated and reversed. This so-called “facial feedback” hypothesis traces back to great nineteenth century thinkers, including Charles Darwin (“repression … of all outward signs softens our emotions”) [2] and William James (“refuse to express a passion, and it dies”) [3], and has evolved into a theory of “emotional proprioception” [4], positing that the muscles of facial...



The opinions expressed in this article are solely those of the author and do not purport to represent the official position or policy of the US National Institutes of Health or Department of Health and Human Services.


This work was prepared by Dr. Matthew V. Rudorfer in his capacity as an employee and officer of the U.S. Government, with no external funding.

Compliance with Ethical Standards

Conflicts of Interest

Dr. Matthew V. Rudorfer has no conflicts of interest.


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Copyright information

© This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection 2018

Authors and Affiliations

  1. 1.Treatment and Preventive Interventions Research Branch, Division of Services and Intervention Research, National Institute of Mental HealthNational Institutes of HealthBethesdaUSA

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