78 ALLURE MAY 20 19
A
couple of weeks before New Year’s
Eve, after hours on NYU Langone’s
dermatology floor, I received Botox in
my forehead for the first time. This is not
because I wanted to fix any lines—I have
a few, and they are fine—nor because
I love the feeling of a needle piercing my
skin eight times in succession, but
because I am kind of sad most of the
time, and I would like not to be.
Beneath the ambient hum of the
building’s HVAC system, Evan Rieder, he
of the round tortoiseshell glasses and
dual board certification in dermatology
and psychiatry, is trying to cure my
depression. First we try some breathing
techniques, then an exercise in which I
clench every part of my body really hard
for a few minutes and then release all of
the tension (it works, kind of). Next
comes some Botox, which has recently
cleared phase-two trials as a treatment
for major depressive disorder, for
reasons I do not yet understand. Rieder
explains that it is particularly effective
among people who have experienced
depressive episodes, which means
I am a very good candidate.
When examining the lines of my face,
the doctor asks me to contort my
features into a variety of different non-
sad expressions, which makes me feel as
though I am rehearsing for a new period
of my life in which I feel a variety of
different non-sad emotions. Rieder asks
me to “look surprised,” and my eyebrows
jump into my hairline. In order to
properly inject the muscles directly
above the bridge of my nose, I have to
contract every muscle in my face at
once, like a hobgoblin.
Afterward, I call my mom to tell
her the good news: In a couple of days,
my forehead wrinkles will be ironed
smooth, and this will make me palpably
happier—again, for reasons I do
not yet understand. “It’s for a story
about whether or not Botox can treat
depression,” I tell her.
“Oh,” she replies. “Well, how do
you feel?”
My forehead hurts. “I guess I
feel OK?”
“That’s good!” she chirps. “I always
feel happier after getting Botox.”
I am depressed,
but it’s not a big
deal, I promise. A chemical
imbalance in my brain infrequently
makes me prone to weeklong
periods of emotional despondency,
which my therapist refers to
as the aforementioned depressive
episodes—an emotional flu that
happens upon me a few times a year.
I take a daily SNRI (an antidepressant)
that I keep on me at all times. I
attend weekly therapy and biweekly
acupuncture. Most of my habits are
devoted to strengthening my immunity
against depressive episodes and other
mood-disorder symptoms, and, like any
other person seeking a cure for their
strange and insoluble affliction, I have
tried a lot of wacko things in search
of a cure. I have floated in a sensory
deprivation tank. I have convection-
cooked my body using infrared therapy
on both coasts of the United States.
Even if these offbeat treatments didn’t
work, I told myself, I would at least have
hilarious stories for decades. Whenever
I was sad, I could just think of the time I
got saltwater in my eye in the middle
of a pitch-black tank buried deep within
a midtown-Manhattan office building,
and I would laugh, really hard, all of the
time, on demand.
But depression doesn’t work in this
way. Even the pills, which I am very
grateful for, fail sometimes. In fact, this
assignment, and my first appointment
with Rieder, dovetailed with a particularly
nasty depressive episode (again,
I am fine!). So I was particularly open to
seeing if “psychodermatology” can
teach anybody anything about mood
disorders and why they work the way
they do. The way we look is so fraught,
so heavy with implication, so bound
to our greater self-esteem that it seems
impossible that it doesn’t have
a measurable influence on the way
our brains work. Before my Botox
appointment, one of my colleagues
raises a theory: Will you feel better just
SKIN DEEPER
