Does Botox Drop Anxiety?

WITH DISEASE SPREAD AND DEATHS, large outbreaks of Covid-19 infection are associated with fear and grief. I don’t know about you, but the limits on non-essential travel and other activities have stressed me.

While I believe that practices such as masking and social distancing (in addition to vaccination) provide immeasurable benefits, I know that many of my patients report associated anxiety.

“Anxiety’s like a rocking chair. It gives you something to do, but it doesn’t get you very far.”

— Jodi Picoult, “Sing You Home“

Mental health in the Covid-19 era

I wonder about the mental health status of my family, friends, and readers. And so I did what I am prone to do; I ran to the available clinical literature.

Fortunately, we have a good resource from the US Centers for Disease Control (CDC). This governmental organization partnered with the Census Bureau to perform the Household Pulse Survey.

This survey describes trends in the percentage of adults with anxiety or depressive disorder symptoms during the past seven days. The researchers also track those who sought mental health services.

You are probably not surprised to learn that from August 2020 through February 2021, the percentage of adults with symptoms suggestive of an anxiety or depressive disorder (over the previous seven days) increased significantly. The odds of such symptoms rose from 36.4 percent to 41.5 percent.

The percentage that offered that they needed, but did not receive, mental health counseling or therapy during the prior four weeks rose from approximately 9 percent to nearly 12 percent. The increases appeared most substantial among adults 18 to 29 years of age and those with less than high school education. Let me state it once again:

Of those surveyed, over 41 percent of folks experienced symptoms pointing to an anxiety or depressive disorder.

In the context of these disturbing statistics, let’s turn to some news about a favorable “side effect” of receiving botox.

“Our anxiety does not come from thinking about the future, but from wanting to control it.”

— Kahlil Gibran

Botox and anxiety

Now comes a new study reporting that people receiving Botox injections at foud different sites — not only the commonplace for injections, the forehead — reported anxiety significantly less frequently than individuals having different treatments for the same conditions.

Botox (botulinum toxin) is a medicine made from a bacterial toxin. The substance is commonly injected with a skinny needle to improve wrinkles, excessive sweating, migraine headaches, muscle spasms, and incontinence.

Let’s look at some intriguing research findings reported earlier this week. Scientists at the University of California, San Diego (USA) worked with two physicians in Germany. The investigators did something clever: They probed the United States Food and Drug Administration’s Adverse Effect Reporting System (FAERS) database.

The FAERS repository is chock full of health information for nearly 40,000 individuals reporting what happened to them at Botox treatment, no matter the reason for having the injections.

Here’s how the researchers did their work: They scoured the database, looking for the absence or reduced anxiety change as a health complaint (controlled to a control group) when taking Botox. Then, the researchers applied a mathematical algorithm to search for differences between Botox users and individuals who received different treatments for the same problems.

The results? The reported anxiety appeared up to 72 percent lower for patients treated with Botox for four of eight conditions and injection sites:

• Facial muscles for cosmetic reasons
• Facial and head muscles for migraine headaches
• Legs and arms for spasm and spasticity
• Neck muscles for a condition known as torticollis (Torticollis is a problem involving the neck muscles that causes the head to tilt down. Sometimes it’s called “wryneck.”)

The researchers did not have enough information for the other four (of eight) conditions and injection sites.

My take

I think this research is not definitive but is hypothesis-generating. The research has a bias — the FAERS database includes only the subset of Botox users who had adverse side effects. Interestingly, the researchers historically reported Botox injections reduced depression less often than patients with different treatments for the same conditions, published in Scientific Reports in July 2020.

We don’t know how Botox might reduce anxiety. The study authors wonder if Botulinum toxins travel to parts of the brain involved in mood. On the other hand, Botox may affect nerve-muscle junctions that might communicate with the brain. Perhaps the anxiety relief is secondary to the success of Botox administration in relieving the underlying problem, indirectly relieving anxiety.

Thank you for joining me in exploring this exciting connection between Botox administration and anxiety reduction. While the study is not definitive, I hope it prompts a closer look at the Botox/mood connection.