Understanding the research into botox and anxiety reduction

In December 2021, research was published in the US journal, Scientific Reports, examining the finding that patients receiving botox had reported a significantly reduced risk of anxiety.   

The study was conducted by researchers* at Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego, in collaboration with two physicians from Germany.

We explore the research and what this may indicate for the future medical use of botox.

What is botox and how is it used?

The botulinum toxin (or botox) is a neurotoxin produced by the bacterium, Clostridium botulinum. It has many uses in aesthetic and medical practice.

Botox is perhaps more commonly known for its ability to reduce the repetitive facial muscle activity that causes wrinkles. It is therefore often used to treat a variety of facial lines such as frown or glabella lines, ‘bunny’ lines and nasolabial folds. Once treated with botox, skin appears smoothed, with deeper lines significantly reduced.

There are also a number of medical uses for botox. These include treatment to help with migraines, hyperhidrosis (excessive sweating), excessive blushing, Bell’s Palsy, enlarged masseter jaw muscle, urinary incontinence, muscle spasms and neck torticollis or dystonia.

Botox works by temporarily relaxing carefully targeted muscles. It blocks the nerve signals which would otherwise cause them to contract.

On average, the duration of botox in the body is around three to four months.

How was the association with botox and anxiety reduction discovered?

Ruben Abagyan, PhD, Professor of Pharmacy and research lead explained that, whereas it is usual for adverse side effects of particular treatment to be reported and tracked by the FDA (the US Food and Drug Administration), their approach to the research was different.

Dr Abagyan and his team decided to investigate any incidental, beneficial effects of botox treatment.

The team scoured the botox treatment side effects database for the absence (or reduced frequency) of anxiety and anxiety-related disorders as a health complaint. This was compared to a control group.

A mathematical algorithm was then applied to look for statistically significant variances between botox patients who received different treatments for the same conditions.

What were the research findings concerning botox and anxiety reduction?

The research team found that the reported anxiety risk was between 22 and 72 percent lower in patients treated with botox for four out of eight conditions, and injection sites.

The four conditions and injection sites highlighted were: facial muscles for cosmetic use; facial and head muscles for migraine; upper and lower limbs for spasm; and neck muscles for torticollis (also called wryneck, muscle-induced twisting of the neck). For the other four conditions studied, results were not deemed statistically robust.

Points to note are that the data was a subset of botox patients who experienced negative side effects. Also, whilst the research team excluded data in which a person was also taking medication to treat anxiety such as antidepressants, the use of other prescription and over-the-counter medications could have been underreported in some cases.

Are there any other research findings that support this?

Dr Abagyan lead a similar study in July 2020, using the same database. The research team found that patients receiving botox injections reported depression significantly less often than patients undergoing different treatments for the same conditions.

Both studies found a decrease in reported symptoms regardless of injection site.

The team believe the specific molecular mechanisms by which botox reduces depression, as opposed to anxiety – while not known – may be different.

Dr Abagyan stated that “They may be related, but there are different pathways responsible for anxiety attacks versus depression”.

Why could there be this link between botox and anxiety reduction?

Dr Abagyan and his co-researchers believe that there are several possible mechanisms, that cause this outcome for botox patients, that warrant further investigation. These are:

• the botulinum toxins could be transported to the regions of the central nervous system involved in mood and emotions,
• the neuromuscular junctions affected by the botox may directly communicate with the brain,
• finally, as botox is often used to treat chronic conditions that may contribute to anxiety, its success in relieving the underlying problem may indirectly also relieve anxiety.

What is the future for botox treatment and anxiety reduction?

Dr Abagyan concluded that research is needed to understand the exact mechanism by which botox reduces anxiety.

Clinical trials will determine the best injection site for the botox, and the appropriate dose, specifically for anxiety.

Information and support for mental health

The NHS mental health services website can help with accessing services and urgent care.

The mental health charity, Mind, offers a wealth of information and support.

For specific information about botox and your suitability for medical or aesthetic treatment, please call us.

* Dr Ruben Abagyan led the study with Tigran Makunts, PharmD, a former research fellow at the FDA who has joined UC San Diego as a research scientist, and German psychiatrists Marc Axel Wollmer and Tillman Kruger.