Summary: Botulinum toxin or Botox can help to quell negative emotions in people suffering from borderline personality disorder.
The bacterial botulinum toxin (BTX) toxin – colloquially known as Botox – is probably known to most people as a remedy for wrinkles. But botulinum toxin can do even more: if injected in the forehead, for example, it can relieve depression.
It also suppresses negative emotions in people with borderline personality disorder who suffer from extreme mood swings.
Professor Dr. Tillmann Krüger, senior physician and head of the research group at the Department of Psychiatry, Social Psychiatry and Psychotherapy at Hannover Medical School (MHH), proved it years ago – together with his colleague Privatdozent (PD) Dr. Marc Axel Wollmer from Asklepios Campus Hamburg at Semmelweis University .
Now psychiatrists have figured out where and how BTX affects the negative program in the brain. Using magnetic resonance imaging (MRI), they visualized neural effects in borderline patients.
Result: botulinum toxin affects the so-called the amygdala or amygdala in the temporal lobe of the brain, where fears are generated and processed.
The work was recently published in the journal Scientific reports.
Feedback between muscles and psyche
Negative moods are expressed on the face in the so-called the area of the frontal gland, i.e. the area of the lower middle forehead. When we are angry or tense, two different types of muscles contract and cause wrinkles or worry lines to appear above the base of the nose.
When botulinum toxin is injected into the glabellar area, it paralyzes the muscles between the eyebrows. Since facial expressions and mental state are closely related, it also reduces the intensity of the emotions.
“A relaxed forehead gives you a more positive feeling, so to speak,” explains Professor Krüger.
In science, this feedback is discussed as the facial feedback theory. In an earlier meta-analysis, Professor Krüger and his team had already shown that injecting BTX into the glabellar area has a positive effect on mood and mood stimulation.
As a result, symptoms of depression improve significantly. “The treatment has several advantages at the same time: since the paralyzing effect lasts for three or more months, the injection should also only be given at these intervals. Rare injections are also less expensive than some other treatment options and have very good patient tolerance and acceptance, ‘explains Professor Krüger.
Botulinum toxin inhibits the constant emotional fire in the tonsil nucleus
And it works for depression as well as borderline personality disorder. About 3% of Germans suffer from this disease, and more than 62% of those affected are women. By breaking the feedback loop between the forehead muscles and the brain, botulinum toxin also changes emotional feedback.
Scientists have successfully demonstrated this in the brains of borderline patients who were treated with an injection of botulinum toxin into the glabellar area. Just four weeks later, patients had significantly reduced symptoms as also shown on MRI scans.
“We were able to see that botulinum toxin inhibits the emotional incessant fire in the nucleus of the tonsils that accompanies the high degree of internal tension in those affected,” says the psychiatrist. The acupuncture control group also showed improvement in clinical symptoms, but not neural effects on MRI. However, the feedback between the muscles and the brain does not only work in the area of the frontal gland.
This is the result of a database study in which prof. Krüger and his colleague prof. Wollmer and which has already been published in the journal. Scientific reports at the end of 2021.
In collaboration with the University of California San Diego, they found that botulinum toxin can also relieve anxiety disorders when injected into the muscles of the head, muscles of the arms and legs, and the muscles of the neck.
Until now, however, the treatment of mental illnesses with BTX has not been covered by the services provided by health insurance companies. The psychiatrist hopes that this will change as the mode of action is further investigated.
Botulinum toxin, colloquially known as Botox, is the most powerful neurotoxin known. It is produced by the bacterium Clostridium botulinum in the absence of air and causes the so-called botulism. Symptoms of poisoning are usually caused by eating poorly preserved food in which a bacterial toxin has accumulated. This inhibits the transfer of arousal from nerve cells to other cells, especially at connections with muscles and blood.
About this borderline personality disorder and news from emotion research
Author: Stefan Zorn
Contact: Stefan Zorn – MH
Image: The image is attributed to Karin Kaiser / MHH
Original research: Open access.
“Neural effects of botulinum toxin glabellar injections using the valence inhibition task in borderline personality disorder” by Tillmann HC Kruger et al. Scientific reports
Neural effects of botulinum toxin glabellar injections using the valuable inhibition task in borderline personality disorder
Previous studies have found that botulinum toxin (BTX) glabellar injection can lead to lasting depression relief. This can be achieved by disrupting facial feedback, which potentially alleviates the experience of negative emotions.
Consequently, BTX glaze injection may diminish the activity of the amygdala in response to emotional stimuli. Borderline Personality Disorder (BPD) is the prototypical state of excess negative emotionality and impulsivity, accompanied by increased responsiveness of the amygdala to emotional stimuli.
To better understand how BTX trackpad can affect the processing of emotional stimuli and impulsivity, we conducted a functional magnetic resonance imaging (fMRI) study.
Our hypotheses were as follows: (1) glabellar BTX leads to increased activation in the prefrontal areas during inhibition, and (2) BTX generally reduces amygdala activity while processing emotional stimuli. Using the emotional go- / no-go paradigm during fMRI, the interference of processing emotions and impulsivity was assessed in a sample of n = 45 women with BPD.
Subjects were randomly assigned to either BTX or serial acupuncture (ACU) head treatment. After 4 weeks, both treatments led to a reduction in BPD symptoms.
However, treatment with BTX was particularly associated with improved inhibitory efficacy and increased activity in the motor cortex. In addition, the processing of negative emotional faces was accompanied by a decrease in the activity of the right amygdala.
This study provides the first evidence that BTX glaucoma injections can modify the central neurobiological and behavioral aspects of BPD. As the control treatment produced similar clinical effects, these neurobiological symptoms may be specific to BTX and not generally correlate with symptom improvement.