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Facial Expression and Predicting and Monitoring Response to Depression Treatment: A Systematic Review.

David Plevin^1,2, Simon Hartmann¹, K Oliver Schubert^1,3,4

¹Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia.

Digital Biomarkers

|February 20, 2026

Summary

Facial expression analysis shows promise as a biomarker for predicting depression treatment response. Increased facial expressivity, particularly in specific facial muscles, correlates with positive treatment outcomes in major depression.

Keywords:

Biomarkers Depression Facial expression Personalized medicine

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Area of Science:

Neuroscience
Psychiatry
Digital Health

Background:

Biomarkers for treatment response in major depression are crucial for personalized medicine.
Facial expression is linked to mood and treatment outcomes in depression.
Facial expression may serve as a predictive biomarker for depression treatment success.

Purpose of the Study:

To systematically review existing research on facial expression as a biomarker for depression treatment response.
To synthesize findings and identify potential digital approaches for facial expression analysis in depression.

Main Methods:

Systematic review of MEDLINE, Scopus, and PsycINFO databases.
Inclusion of English-language publications assessing facial muscle activity or expression in relation to depression treatment.
Risk of bias assessment using a National Institutes of Health quality tool.

Main Results:

12 studies with 389 participants were included.
Facial expression assessment methods varied, including electromyography and automated tools.
Increased facial expressivity, specific muscle activity (corrugator, zygomatic), and reduced lip tightening correlated with treatment response.

Conclusions:

Facial expression analysis presents a potential avenue for identifying biomarkers of depression status.
Facial expression holds promise for predicting treatment response in major depression.
Further research is needed to address heterogeneity in assessment tools and demographics.