Antidepressant effects of facial botulinum toxin a injections: Insights from randomized controlled trials
In brief
Facial Botox lowers depression scores by about one standard deviation
A meta-analysis of eight randomized trials involving 636 adults found that glabellar botulinum toxin A injections reduced depressive symptoms roughly one standard deviation more than placebo and performed similarly to sertraline. Adverse events were mild and limited to transient local reactions, offering a non-systemic option for patients who cannot tolerate oral antidepressants.
- Journal
- Journal of affective disorders (Q1)
- Published
- 30 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Zhengyu Gao, Xiaoqin Chen, Xiaoming Yu, Luoman Hu, Chengfei Gao
- PMID
- 42669382
- DOI
- 10.1016/j.jad.2026.122443
Why clinicians should know about it
- Picked for Psychiatry and Mental Health (top studies of the week, 6 September 2026): RCT meta‑analysis of facial botulinum toxin for depression
Abstract
Depressive disorders cause significant global disability, yet oral antidepressants often have systemic side effects and delayed onset. This systematic review and meta-analysis evaluated the efficacy and safety of facial injections of Botulinum toxin A (BoNT/A) compared with placebo and the active antidepressant sertraline. We searched PubMed, Embase, Cochrane CENTRAL, Web of Science, and PsycINFO for randomized controlled trials (RCTs) from inception to December 2025. Eight RCTs comprising 636 participants were included. Facial BoNT/A injection was associated with a significant reduction in depressive symptoms compared with control conditions (SMD = -0.81; 95% CI, -1.23 to -0.38; p < 0.001). Subgroup analysis revealed that BoNT/A was superior to placebo (SMD = -1.04) and demonstrated efficacy comparable to sertraline (SMD = -0.23). Regarding injection strategies, while standard glabellar protocols demonstrated significant antidepressant efficacy, the high-dose pan-facial subgroup showed no statistically significant difference compared to controls. Anxiety scores did not differ significantly between groups. While overall adverse event rates were similar to controls (RR = 1.04), BoNT/A was associated with transient local reactions, avoiding the systemic side effects observed with sertraline. Facial BoNT/A injection represent an effective, safe treatment for depression. These findings provide valuable insights into a non-systemic therapeutic alternative, particularly for patients intolerant to oral antidepressants or those with polypharmacy burdens. PROSPERO REGISTRATION NUMBER: CRD420261277524.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.