Summary: Botulinum toxin, or Botox, helps reduce negative emotions for people suffering from borderline personality disorder.

Source: MHH

Botulinum toxin (BTX) – commonly known as Botox – is probably the most well-known anti-wrinkle drug. But botulinum toxin can help even more, if injected in the forehead, for example, it relieves depression.

It also relieves negative emotions in people with borderline personality disorder, who suffer from extreme mood swings.

Professor Dr. Tilmann Krüger, Senior Physician and Research Group Leader of the Clinic of Psychiatry, Social Psychiatry and Psychotherapy at the Hannover Medical School (MHH) confirmed this years ago – together with his colleague Privatdozent (PD) Dr. Mark Axel Vollmer from the Semmelweis University Asklepios Campus Hamburg.

Now psychiatrists have discovered where and how BTX affects the negative programming in the brain. With the help of magnetic resonance imaging (MRI), they observed neurological effects in borderline patients.

The result: botulinum toxin affects the amygdala, or almond nucleus, in the temporal lobe, where fears are generated and processed.

The work was recently published in the magazine Scientific reports.

Interactions between muscles and psychology

Negative emotions on the face called the glabellar region, in the area of ​​the lower middle of the forehead. When we are angry or stressed, two different types of muscles contract and cause lines above the nose, or stress lines, to appear.

When botulinum toxin enters the glabellar region, it paralyzes these muscles between the eyebrows. Since facial appearance and psychological state are closely related, this also reduces the intensity of emotions.

“A relaxed forehead conveys a more positive feeling,” says Professor Kruger.

In science, this feedback is explained as the facet feedback theory. In an earlier meta-analysis, Professor Krueger and his team had previously shown that BTX injection into the glabellar region had a positive effect on mood and emotional arousal.

As a result, symptoms of depression improve significantly. “The treatment has several advantages at once: because the paralysis lasts for three or more months, injections only need to be given at these intervals. Intermittent injections are less expensive than some treatment options and are well tolerated and accepted by patients,” explains Professor Kruger.

Botulinum toxin inhibits the emotional constant fire in the tonsil nucleus

And this 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 interrupting the feedback loop between the muscles of the forehead and the brain, botulinum toxin alters sensory feedback.

This shows that the researcher has a model of the brain and the needle
Botulinum toxin injection has shown that it affects not only the muscles, but also the emotional control center in the brain: Prof. Dr. Tillman Kruger. Credit: Karin Kaiser / MHH

The researchers were able to confirm this in the brains of borderline patients treated with botulinum toxin injections in the glabellar region. After just four weeks, the patients had a significant reduction in symptoms, which can also be seen in the MRI images.

“We were able to see that botulinum toxin suppresses the emotional constant fire in the tonsil nucleus, which accompanies the internal stress of the affected people,” said the psychiatrist. A comparison group treated with acupuncture also showed improved clinical symptoms, but did not show neurological results in MRI examination. However, the feedback between the muscles and the brain does not work only in the glabellar region.

This is the result of a database study in which Professor Krueger and his colleague Professor Vollmer participated and which was published in the journal. Scientific reports By the end of 2021.

In collaboration with the University of California, San Diego, they discovered that botulinum toxin can alleviate anxiety disorders when injected into the muscles of the head, muscles of the upper and lower legs, and neck muscles.

However, until now, the treatment of BTX mental disorders is not included in the services provided by health insurance companies. The psychiatrist hopes that this will change when the mechanism of action is better investigated.

Botulinum toxin, colloquially known as Botox, is the best known neurotoxin. It is produced by the bacterium Clostridium botulinum in the absence of air and causes botulism. The symptoms of poisoning are usually caused by eating poorly preserved food in which bacterial toxins are stored. This prevents impulses from nerve cells to other cells, especially at muscle and blood junctions.

watch out

This shows when someone adds a pinch of sugar to black coffee.

So borderline personality disorder and mood research news

Author: Stefan Zorn
Source: MHH
Contact: Stefan Zorn – MHH
Image: Image courtesy of Karin Kaiser/MHH.

Preliminary study: Open Access.
Neurological effects of glabellar botulinum toxin injections using a proven inhibitory function in borderline personality disorder” by Tillman HC Kruger et al. Scientific reports


Neurological effects of glabellar botulinum toxin injections using a proven inhibitory function in borderline personality disorder

Previous studies have shown that glabellar botulinum toxin (BTX) injections can permanently relieve depression. This can be achieved through disruption of the face feedback loop, which can reduce the experience of negative emotions.

Accordingly, glabellar BTX injection may attenuate amygdala activity in response to emotional stimuli. Borderline Personality Disorder (BPD) is a prototypical condition characterized by excessive negative emotionality and impulsivity in an elevated amygdala response to emotional stimuli.

To improve understanding of how glabellar BTX affects emotional stimuli and emotional processing, we conducted a functional magnetic resonance imaging (fMRI) study.

Our hypotheses were (1) glabellar BTX leads to increases in prefrontal areas during inhibitory performance and (2) BTX generally reduces amygdala activity during processing of emotional stimuli. Using an emotional go-no-go paradigm during fMRI, emotional processing and emotional interference were assessed in a sample of n = 45 women with BPD.

Subjects were randomly assigned to BTX treatment or continuous scalp acupuncture (ACU). After 4 weeks, both treatments led to a reduction in BPD symptoms.

However, BTX treatment was specifically associated with improved inhibitory performance and increased activity in the motor cortex. In addition, the processing of negative emotional faces reduced the activity of the right amygdala.

This study provides the first evidence that glabellar BTX injections can alter central neurobiological and behavioral aspects of BPD. Because the control treatment produces similar clinical effects, these neurobiological findings may be specific to BTX and may not be a general symptom improvement.

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