Smooth the brow, brighten the eye ... " the pioneering psychologist William James wrote in 1890, describing a self-help technique for overcoming depression, "and your heart must be frigid indeed if it does not gradually thaw." In James's lifetime there was no easy way to follow this advice because Botox hadn't been invented. But today, smoothing the brow by paralyzing the corrugator supercilii muscles is the work of minutes--or so reasoned Eric Finzi, a dermatologist in Chevy Chase, Md. A few years ago Finzi got the idea of in-jecting botulinum toxin A--the compound marketed as Botox--into the foreheads of patients suffering major clinical depression. According to a paper published last week in the journal Dermatologic Surgery, it helped in nine out of 10 cases--nearly twice the success rate claimed for antidepressants.
That's despite the fact that it seems to make no sense. Frowning is an expression of an underlying emotional state. To cure depression by banishing frowning is like hoping to cure a cold by stifling a sneeze. But the body has its own logic, based largely on internal monitoring and feedback. To a surprising degree, the facial muscles control emotions, as well as the other way around. Patients with Mobius syndrome, a partial facial paralysis, seem not to experience emotions with the same intensity as normal people. "I thought if I could interrupt this cycle and prevent the frown, maybe a depressed patient would get better," says Finzi.
His patients, all women aged 36 to 63, were evaluated by a clinical psychologist (his coauthor, Erika Wasserman) and found to be clinically depressed; seven of the 10 had been treated with antidepressants. Two months after their injections they were evaluated again and, in all but one, the depression had lifted. "It wasn't a case of feeling better because I looked better," says one of them, Kathleen Delano, 45. She didn't have the brow furrows that Botox is meant to erase, so her "cosmetic benefit" was small. Finzi--who has applied for a patent on using Botox for depression--admits that much larger, controlled studies will be needed to confirm his results. Clinical psychologists reacted to the study mostly with skepticism, although some think Finzi might be on to something. One, Joshua Fogel of New York, pointed out that there are studies showing that smiling promotes the release of mood-elevating endorphins in the brain, so the opposite could also be true. Finzi's study reminded psychologist Andrew Elmore of a patient who was a soap-opera actress. Spending her working day sobbing over her cheating husband left her depressed in real life. Elmore employed a low-tech approach: he got her to ask the writers to make the other characters be nicer to her.