Science of Smiling in HuffPost Healthy Living

Dr. Eric Finzi and Dr. Norman Rosenthal’s research study findings featured in The Science of Smiling by Andrew Merle for Huffington Post Healthy Living

When we are happy, our natural response is to smile. But if you flip that around, does the reverse hold true? When we smile, is our natural response then to be happy?

Science says yes.

In fact, even faking or forcing a smile reduces stress and makes you happier….

…Another study looked at the effect of facial expression on depression. The experimenters, Eric Finzi (cosmetic dermatologist) and Norman Rosenthal (professor of psychiatry at Georgetown Medical School) worked with 74 subjects who all had major depression, and either gave them a Botox injection between the eyebrows that prevented frowning, or a placebo saline injection that did not affect the facial muscles.

The findings showed that, six weeks after the injection, 52 percent of the non-frowning Botox group showed a reduction in their depression, compared to only a 15 percent improvement rate for the placebo group. The results indicate that putting on a happy face actually makes you happier.

It seems that the simple act of a physical smile, authentic or not, tricks your brain into thinking you’re actually happy. Smiling also triggers us to think back to joyful memories, further improving mood.

In addition to lifting mood and reducing stress, other research has shown that people who smile are thought to be more friendly and likeable, and smiling actually makes those around you cheerier as well.

All of this shows that the old sayings actually deliver great advice — it’s time to turn that frown upside down, grin and bear it, and say cheese!

LINK to Article

Botox for Depression, Eric Finz, Faces of Emotion


For more insight in to the study findings READ Dr. Eric Finzi’s Book, Face of Emotion: How Botox Affects Our Mood and Relationships


New Botox for Depression Research Published in Pharmacopsychiatry

Treating Depression with Botulinum Toxin: A Pooled Analysis of Randomized Controlled Trials


Introduction: Botulinum toxin A (BTA) injection into the glabellar region is currently being studied as a treatment for major depressive disorder (MDD). Here we explore efficacy data of this novel approach in a pooled analysis.

Methods: A literature search revealed 3 RCTs on this topic. Individual patient data and clinical end points shared by these 3 trials were pooled and analyzed as one study (n=134) using multiple regression models with random effects.

Results: In the pooled sample, the BTA (n=59) and the placebo group (n=75) did not differ in the baseline variables. Efficacy outcomes revealed BTA superiority over placebo: Improvement in the Hamilton Depression Rating Scale or Montgomery-Asberg Depression Rating Scale 6 weeks after baseline was 45.7% for BTA vs. 14.6% for placebo (p<0.0001), corresponding to a BTA response rate of 54.2% (vs. 10.7%) and a BTA remission rate of 30.5% (vs. 6.7%).

Discussion: Equalling the status of a meta-analysis, this study increases evidence that a single treatment of BTA into the glabellar region can reduce symptoms of MDD. Further studies are needed to better understand how BTA exerts its mood-lifting effect.  Read More…



Botox for Depression? You’ve Got to be Kidding

 I have always gravitated to research approaches that are off the beaten track, such as the study of SAD and light therapy that I spearheaded at the National Institute of Mental Health (NIMH) over 30 years ago. At that time, seasonal affective disorder (SAD) had not yet been identified: we went on to name it and describe its typical symptoms.  Light therapy, as it’s used for SAD, was unknown.  My colleagues thought I had lost it. Yet now we recognize that millions of people the world over suffer from SAD and countless people have benefited from light therapy.

Botox for Depression, Eric FinziIt was this same out-of-the-box instinct for a winner that went on alert when my colleague, Dr. Eric Finzi, a local dermatologist approached me with a novel idea for treating depression.  Some years before, after leaving the NIMH, I had opened up a private clinical research organization in the hope of doing innovative and creative studies. Although that was possible to some extent (for example, I was able to study the effects of Transcendental Meditation on bipolar disorder and post-traumatic stress disorder), the reality of the work revolved mostly around testing new drugs. So, I was always on the lookout for something really different and exciting.

Botox for Depression, Research, Dr. Eric Finzi, Dr. Norman E. Rosenthal, Charles Darwin, Faces of Emotion Dr. Finzi had read the work of Charles Darwin and the famous psychologist William James, both of whom had suggested that cues from the body, including the face, had a powerful effect on human emotions.  Darwin called the frown muscles between the eyebrows “the grief muscles,” and suggested that they were not just a reflection of sorrow, but also fueled it. An extensive subsequent literature supported this “facial feedback hypothesis,” and numerous experiments showed that facial expressions affect the way we feel.

Botox for Depression, Eric Finzi, Faces of Emotion

 Finzi has described this history in a highly readable book, The Face of Emotion.  Now Finzi had an idea as to how these insights could be used to treat depression – by means of botulinum toxin (Botox), which is known to paralyze muscles.  How would it be, he wondered, if we paralyzed the frown muscles between the eyebrows in a double-blind study with saline as a control? An encouraging pilot study suggested it might work.  But this would now need to be tested in a controlled study. Would I be interested in conducting such a study in my research organization?  Well, I loved the idea! And that was the beginning of an enjoyable collaboration. 

Emotion Revolution, Dr. Norman Rosenthal Another reason why Finzi’s idea appealed to me so much is that over a decade before he approached me, I had written a book about the science of emotion, called The Emotional Revolution.  In it I wrote:

Among the sensory nerves that influence our mood are those that pass directly through the skull and into the brain.  These are known as the cranial nerves.  Exposure to light stimulates one pair of these nerves, the optic nerves. Another pair, the olfactory nerves, transmits sensations of smell to the brain.  The fragrance of lemons lifts the mood of depressed patients with SAD.

FrownIt was highly plausible to me that frowning might send signals to the brain via different cranial nerves – the facial and trigeminal nerves.  But in this case, it seemed, the signals aggravated a person’s mood rather than relieving it.  So it made all the sense in the world to me that blocking these signals might reverse depression. 

So Finzi and I embarked on a controlled study of Botox for depression in collaboration with a great team of psychiatrists and administrators at my research organization.  We entered 74 depressed people into a double blind, placebo controlled study and when we finally analyzed the data, the results were clear and strong. Botox beat placebo, significantly reducing depression levels, regardless of whether patients were already on antidepressants (to which they had not responded) or were untreated.

The results of the study are due to appear in the Journal of Psychiatric Research in May 2014, but the abstract is already available online.  READ THE ABSTRACT

Botox for Depression, Research, Dr. Eric Finzi, Dr. Norman E. Rosenthal, Botox, Depression As a psychiatrist who has treated many people with depression, I am truly excited at this new treatment option. Although there are many available treatments for this very painful affliction, they are often only partially effective and have troublesome side-effects.  I am delighted that we now have a new treatment option which can be used safely alongside all other treatments (as the Botox acts only locally in the muscles and is not absorbed).  In addition, when properly administered by a trained person, Botox has few if any side-effects.  So, what’s the catch?

Well, first of all, as with any treatment for depression, some people don’t respond; second, it is expensive – an average treatment costs about $400; and finally, the effects of Botox wear off after about 2 to 3 months, so treatments may need to be repeated.  I hope that, with replication of our findings and wider use, insurance coverage may become available.  In the meanwhile, for someone suffering from the agonizing pangs of depression, the benefit of Botox may be well worth the cost.

For an additional perspective check out the following link to a New York Times Op Ed piece by Dr. Richard Friedman on the subject – Don’t Worry, Get Botox.

Wishing you Light & Transcendence,




Botox for Depression: From Darwin to Botox

Botox for Depression, Eric Finzi, Norman Rosenthatll

Botox for Depression, Eric Finzi, Norman Rosenthatll

This journey started when I was a little boy, seeing my mother’s pain, and led unexpectedly to using botulinum toxin to treat depression. Sounds pretty far –fetched, but then many scientific discoveries are only logical in hindsight. I will never forget the etched and furrowed brow of my depressed mother – her suffering became a memory that inspired me to try and figure out what role our facial expressions play in our mental health.

Botox for Depression, Eric Finzi, Norman Rosenthatll

Augustine, Attitudes Passionelle, resin on wood, Finzi 2003

Serendipity drew me into the facial expression field- I am an artist and was intrigued by a riveting series of photographs of hysteric and depressed patients from the 19th century in the Parisenne hospital Salpetriere. I began working on paintings based on these women. To try and understand their world better I read authors from their time.Botox for Depression, Charles Darwin, Eric Finzi, Norman Rosenthall 
Freud led to Darwin’s gem of a book, The Expression of Emotions in Man and Animals from 1872. Wow! Reading this wonderful but relatively unknown work of Darwin’s opened my eyes to a new way of viewing emotion. Darwin and William James, the American psychologist, both recognized that the bodily expression of our emotions really is the emotion, and that our facial expressions are a central driving force of our emotions. Botox for Depression, Charles Darwin, Expression of the Emotions in Man and Amimals, Eric Finzi, Norman Rosenthal, Botox, Depression

I found 40 years of research demonstrating that facial feedback to our brains really occurs. The more I read, the more I was convinced of the importance of facial expressions for our emotions and our mental health. Our emotions are embodied by our faces, embodied by the muscles that help move our lips, our eyes, our eyebrows. You need your smile to help you “feel” the emotion. Conversely, frowning will negatively affect your thinking, coloring your view of the world around you. But I realized that very few people were aware of this line of reasoning, or of why Botox could possibly help ones mood.

Botox for Depression, Eric Finzi, Norman Rosenthatll More than ten years ago I hypothesized that Botox could help control the flow of negative emotions by quieting the facial muscles that really express negativity, the muscles between the eyebrows that help create the frown. In 2003, I began a clinical trial to test my hypothesis that Botox inhibition of the frown muscle could help depressed patients. My 2006 study, Treatment of Depression with Botulinum Toxin A: A Case Study showed that nine of the ten patients were no longer clinically depressed after Botox injections into their frowns. Exciting but just the beginning! Although the press covered the study around the world few seemed to understand the science behind the experiment. Botox was an emotional molecule for many, which distracted attention from the real science behind the study. I realized that the message would need to be much clearer – so I began to write a book about the science  behind my study  and what led to my hypothesis– explaining why facial expressions could be used to treat depression, why frowning might send signals to the brain making one more depressed .Botox for Depression, Eric Finz, Faces of Emotion Last year I published “The Face of Emotion: How Botox Affects Moods and Relationships” (Palgrave Macmillan), providing a framework for understanding the therapeutic power of our facial expressions. In it I wrote:

The brain is measuring the strength of the frown muscle contraction, weighing it against the strength of the smile, which can been seen as the pulse of the positive feelings of happiness – and then producing an emotion. I call this emotional proprioception- just as your mind tracks the smallest movements of your hands or feet, it is tracking those little muscles that control your face.

Botox for Depression, Norman Rosenthall
The next step was to repeat my clinical trial, but this time with more patients and in a trial that was blinded and controlled. I had the good fortune to be introduced to a really open-minded and astute psychiatrist, Norman Rosenthal, a kindred spirit who had worked for many years at the National Institutes of Mental Health before heading up a clinical trial center. So Rosenthal and I began our fruitful collaboration and embarked on a controlled study of Botox depression with his fine team of psychiatrists. We entered 74 depressed people into a double blind, placebo controlled study and when we finally analyzed the data, the results were clear and strong.  Botox beat placebo, significantly reducing depression levels, regardless of whether patients were already on antidepressants (to which they had not responded) or were untreated.

The results of the study are due to appear in the Journal of Psychiatric Research in May 2014, but the abstract is already available online. READ THE ABSTRACT

As a son who watched helplessly as his mother suffered so miserably from depression, I am heartened at a potential new treatment option for this debilitating disease. And I am encouraged by discussion of our new study by Dr. Richard Friedman, in an Op Ed piece in the The New York Times Sunday Review section on March 23, 2014.   Only by much dialogue that generates interest among mainstream physicians will the research be propelled along. Although there are many available treatments for this very painful affliction, none were successful for my mother. I hope that, with replication of our findings, FDA approval will eventually follow, and someone else’s mother will be able to live a normal life.

Eric Finzi