I’ve had Botox, and I never thought I would. But not for cosmetic reasons. And I think I may be experiencing more than the intended benefits to my treatment.
I’ve always had migraines, but I’ve lost a year of my life to nearly daily symptoms of uncontrolled, unmanageable hemiplegic migraines. I tried changing my diet, managing stress, losing weight, adding anti seizure meds, calcium channel blockers, magnesium infusions…and I was still suffering. My neurologist suggested Botox and I kept putting it off, wanting to try everything else first. I was skeptical that it would be effective, how could paralyzing the muscles outside your head affect the inside of your head? It didn’t make sense to me. Plus I was not keen on having 50 needles poked into my head, silly me.
But I did the research, and I agreed to give it a try. I was at the point that I had nothing to lose. My quality of life could not get worse. I either spent every second in fear of a migraine, about to get a migraine, in the middle of a migraine, or recovering from one. An attack would last days to weeks, with the muscle weakness not recovering in between.
I had Botox for migraines in the end of March. That same day of my treatment, my mother passed away. Two weeks later I had spinal surgery. Needless to say, but I’m saying it anyway to be exceedingly clear, this a HIGHLY stressful time period. I should be suffering a worsening of depression, PTSD, migraines, etc right now.
But I’m not. I feel good.
Huh? What’s up with that?
I tried giving myself and my new counselors credit, which I did a little, but it didn’t add up. Something had drastically shifted in my brain. I feel lighter. I realized I haven’t been fighting away suicidal thoughts and images all day long. I’ve felt loved, and connected to my family. Instead of the horrifying void, the usual ache of emptiness, I feel the warmth when my kids hug me. This is new, spectacularly new, and amazing.
So I started thinking. Of course I started thinking, it is what I do best. Start up the old analytical engine. What happened? Why now? What lifted my depression? What did I do differently? I racked my brain until I had what I thought at the time was a silly thought. Hmmm, I never had Botox before… that was new.
Now you may be wondering if the Botox worked for my migraines, and I am pleased to report that I have not had a migraine since right after waking up from surgery, 5 weeks ago! This is the longest stretch of migraine free time I have had in years, and no hemiplegia. So is that enough to account for the shift in mood? Perhaps…but I don’t think so, because I used to only have a few migraines a year and still battled some level of depression and suicidal ideation most of the time prior to the hemiplegia.
So I did some research, and it turns out that Botox is actually being explored as a treatment for Depression. I was stunned. I’ll share some of the links to the research here in a bit, but the main idea for why it may work is fairly simple. Botox in your forehead prevents you from making several negative expressions, especially frowning and furrowing the brow from sadness, concern, anxiety, and fear. Preventing the face from expressing the emotion breaks the feedback loop those muscles send to the brain – the exact science behind preventing migraines actually. Put simply – It gives the brain a rest and gets you unstuck, out of the rut.
So your brain gets less “I’m sad” feedback from your face. That’s a good thing. But take this a step further. You manage to go out grocery shopping, guess what, the people there get less “I’m sad” feedback from you too. They smile at you warmly because you no longer seem unapproachable. Suddenly your world is full of more positive social interactions instead of everyone asking you what is wrong.
I used to think the smile I plastered on my face was a good mask, a good disguise for my pain. But I can tell you now, after seeing the grimace actually gone, it wasn’t a good disguise at all. I only thought I was hiding it. It was still there in my eyes. This kinda wrecks a lot of what I thought I knew, but, that’s okay, because I didn’t like the world I knew.
“Comparing the scores at the six week visit versus baseline, there was a significant improvement in the OBA group compared to the placebo group; there was a 47.0% reduction in MADRS scores for OBA, versus a 20.6% reduction for placebo subjects…”
The MADRS is an interview given by clinicians to assess depression. I’ve included screenshots of it here (taken from http://narr.bmap.ucla.edu/docs/MADRSstructuredInterview.pdf) in case you are curious of the questions it asks. It is short, but because it involves a face to face discussion with the patient, it can provide an accurate snapshot of mood and functioning. They usually give me the Beck Inventory to fill out myself at my counselor’s office, which is similar, but I think could be less accurate.
The conclusion of Finzi and Rosenthals study stated “There are several possible mechanisms by which OBA(Botox) may help alleviate depression. First, frowning may affect the way people feel about themselves when they look in the mirror and the way others respond to them. OBA, by reducing the level of frowning may cause others to respond in a way that influences mood favorably. Happier facial expressions may influence mood by facilitating more positive social interactions with others (Heckmann et al., 2003). Finally, in line with the facial feedback hypothesis that inspired this study, frowning may in and of itself be depressogenic . Thus, reduction in frowning may be in and of itself therapeutic. We suggest that the brain continuously monitors the relative valence of facial expressions and that mood responds accordingly. We term this emotional proprioception (Finzi, 2013), and suggest that it represents an important pathway for the brains’ evaluation of emotional states. According to this model, the brain continuously assesses the extent of facial muscle contraction and muscle tension by proprioception. One can view the state of corrugator muscle tension as part of a neuronal circuit involving the brainstem, with motor input from the facial nerve and sensory afferents from facial and trigeminal cranial nerves. OBA treatment of the corrugator muscle, would interrupt the normal circuitry, reduce distress signals to the brain and thereby influence mood in a favorable way. This model is also supported by work showing that OBA treatment of the frown muscles modifies emotional perception (Niedenthal et al., 2009; Neal and Chartrand, 2011) and amygdala activation (Hennenlotter et al., 2009). “
I am excited and hopeful by this research and by my own results. As someone who has literally tried dozens of psychiatric meds over the past two decades, all with little, no, or worsening affect of my mood, thoughts, suicidal feelings and imagery, lack of connection to others around me. I think my nervous system has always been on the fritz, overworked and overwhelmed since an early age. My parents didn’t smile at me. I didn’t learn to smile, I learned to frown or be tense. I learned not to cry. I learned to suppress. Botox in my forehead took away my control of that tension and suppression and gave those tired muscles a break, and possibly, those tired nerves a break too. Make sense?
Some of the scientists seem very against this treatment, despite early evidence it works well. I can tell you that I had no cosmetic concerns. I don’t even wear makeup on a regular basis. I’m so fair skinned I have avoided the sun my entire life, so I don’t have wrinkles yet, only freckles. The Botox did make me appear more relaxed and less sad, but not younger. I was actually more self conscious of my appearance as the injection sites left red marks across my pale forehead that looked like the big dipper constellation that took weeks to disappear. I did not feel better about that. And yet I was already not frowning and not showing my pain as obviously, random strangers were not making the “you look tired, rough day?” comments to me.
And as I said, this antidepressant effect was not my intended goal. I was attending therapy to decrease suicidal thoughts and thought I had months or years to go. I was just bopping around the house when I realized they weren’t there, and then I had to think really hard about when was the last time I had one, (it’s a myth you always miss something when its is gone) so I checked my journal and it was the day before Botox. It is in my journal. Nothing entered after that. Woah, right? No pill has ever done that.
Now did my mother’s death and those events give me some soul searching and freedom of spirit also? Yes of course. And the success of my spinal surgery was of uplifting. Maybe all of these things needed to happen in combination. Maybe only one alone would have only given me partial relief.
I’m not going to waste it though. I’m going to use my newly found mental energy to continue healing, focus on my PTSD therapy, creating and conquering goals that used to seem impossible because I was consumed with simply wanting to be alive and fighting off those dark thoughts. I want to be a better me, a better wife, a better mom. Me…but healthy. Hard to envision, but still I do want it, and I won’t give up.
Because don’t get me wrong. I’m not cured. Although I think Botox may have helped me get further down my recovery path, I still have stuck points and fears and social anxiety and insomnia and nightmares…and the list goes on. But my depression has lightened, I can even feel some hope trying to sneak in, like a foreign invader.
I joke and smile and sincerely enjoy more moments of each day. I still struggle each day too. I still struggle to get up out of bed, to take care of myself, to remind myself I am worth all this trouble. The difference is now when I struggle, I don’t immediately think death would be better. In fact, I’m starting to think that’s a horrible idea, and that I really should stick around and start living this life for me, somehow. I don’t know how yet, but I’m confident there is a life for me on this planet. Somehow. (That is supposed to sound triumphant, not corny, so if you get it, you get it, if you don’t, well, then you haven’t been plagued by suicidal thoughts for most of your life)