The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time

by Alex Korb

turns out that the circuit for paying attention influences the circuit for emotion, and vice versa.2 And while this is true of every human’s brain, it is more exaggerated in people with depression, even in people at risk for depression.

only their left ear or only their right ear. The researchers found that the amygdala responded to the angry voice whether or not the person was paying attention to it. The amygdala’s response to emotion is not under conscious control.

This demonstrates that you do not have full control over your brain’s automatic emotional response, but you do have some control.

The brain’s inherent emotionality is exaggerated in depression.

those at risk for depression, were more likely to interpret neutral facial expressions as being emotional.7 On top of that, they were more likely to misinterpret neutral expressions as being sad.

Depressed people are more likely to believe friends are frowning at them, mocking them, or ignoring them—even when they aren’t. It’s easy to see how the downward spiral starts from there. In addition, people with depression have brains that fixate longer on emotional information.8 For

Losing five dollars makes you more upset than finding five dollars makes you happy. Having a friend tell you you’re beautiful doesn’t quite balance out the effect of another friend telling you you’re ugly.

All of this means that to be happy in our daily lives, we need a high ratio of positive to negative. And it turns out, after considerable study, that ratio is three to one.

On top of that, if your brain simply ignores the positive events that happen to you—as is often the case with depression—you might need an even higher ratio.

And it’s often a helpful trait. For example, you wouldn’t want an optimistic structural engineer—“I’m pretty sure that bridge will hold up.” You want one who checks every calculation for a mistake; you want an expert at anticipating what might go wrong. Unfortunately, when this focus on the negative gets expanded to everyday life, it can dramatically impede our happiness.

The Negative Bias Doesn’t Fall Far from the Tree Take a look at your family tree. Are there a lot of branches suffering from depression or anxiety? Mood disorders run in families. The children of depressed parents have a higher chance of developing depression for many reasons, including genetics, early childhood experiences, and learned behaviors.

A large part of this bias comes from the fact that being in a bad mood increases amygdala reactivity. The bad mood doesn’t even have to be terribly bad to elicit a mood bias.

Notice what you notice. You can’t control the random bits of information that pop into your head. But you can start to notice your biases. When you get annoyed that you’re stuck at a red light think, Oh, that’s interesting. I noticed this red light, but I didn’t notice the last green light I made. In short, try practicing nonjudgmental awareness. Nonjudgmental awareness is a form of mindfulness that simply means noticing without reacting emotionally, even when things don’t turn out as you expected. Awareness does not require emotion, because emotion and awareness are mediated by different brain regions. Noticing a mistake might automatically trigger the emotional amygdala, but becoming aware of your own reaction activates the prefrontal cortex, which calms the amygdala.25

When starting a new relationship or changing jobs, your brain may automatically interpret the new situation as something bad. But it’s not bad; it’s just unknown. And for almost anything worth having (true love, a great job) you have to pass through some period of uncertainty. We have to constantly remind ourselves that our brains may be skewing the unknown toward the negative, so we don’t miss out on the potentially awesome rewards on the other side.

That’s because your perception of pain is greatly influenced by your mood and motivation.

Thus, compared to nondepressed people, they had a more visceral and emotional response to the possibility of pain and even considered it more likely to occur.

Lower amygdala reactivity with a hug. A hug, especially a long one, releases a neurotransmitter and hormone called oxytocin, which reduces the reactivity of the amygdala (chapter 11).

Thus, if a depressed person and a nondepressed person both burn their hand on the stove, the depressed person is more affected by the pain. The brain’s response to pain is one reason that people with chronic pain are more likely to develop depression, and vice versa.

Thus, in depression, you’re more likely to store more bad memories than good ones. On top of that, because of context-dependent memory, depression makes it harder to remember happy memories and easier to remember bad ones.

Recognizing that you’re viewing your own past through the sunglasses of your current depression can help you realize that your life hasn’t always been this bad.

So just because your brain circuits have a natural inclination toward negativity doesn’t mean they have to stay that way forever. Maybe medication is the answer, or one of many other ways to modify brain circuits, which we’ll discuss in later chapters. The point is that improvement is possible.

How to increase norepinephrine. Surprisingly simple things can help increase norepinephrine—and thus decrease the negative bias—such as exercise, a good night’s sleep, and even getting a massage. We’ll discuss these in more detail later in the book (chapters 5, 7, and 11, respectively).

To combat pessimism, you can strengthen the brain circuits responsible for optimism. The first step is to simply imagine the possibility of positive future events. You don’t have to believe they will happen, just that they could happen. It’s possible you could find true love tomorrow. It’s possible that you could find a better job. It’s possible that things won’t turn out in the worst conceivable way. Recognizing that good things are possible activates the lower (ventral) anterior cingulate.35 Importantly, the ventral anterior cingulate helps regulate the amygdala, so admitting the possibility of good things helps control the brain’s negative bias.

The second step to strengthening optimism circuits is not just recognizing that good things could happen, but expecting that they will happen. Expecting positive events also activates the ventral anterior cingulate,36 as well as prefrontal areas that also help control the amygdala.

Unfortunately, Billi’s weight problems and mood problems are intertwined. When he’s feeling down or stressed, food makes him feel better. Yet being extremely overweight contributes to his depression (do I need to repeat “downward spiral” again?).

Habits are, by definition, hard to change. And some habits are so deeply ingrained that we don’t believe they can be changed. Fortunately, the first step to accomplishing change is simple awareness, and the second step is believing it to be possible.

We tend to think that most of our actions are driven by conscious intention. In fact, most are impulses or routines—not induced by a particular thought, just an automatic response. In a word: habits.

So if bad habits aren’t helpful to us, why do we keep doing them? Because the striatum, unlike the prefrontal cortex, is not rational, at least not in the way you usually define “rational.”

Bad habits can generally be classified as either impulses or routines. Impulses are actions driven by a momentary desire, like clicking on a Facebook link. By contrast, routines are not driven by desire but are actions we take simply because we’ve done them so many times before.

The prefrontal cortex is the only part of the circuit that cares about your long-term well-being, but unfortunately, it often gets outvoted. To

The problem is that the dopamine that is released in anticipation of pleasure actually motivates the actions that lead to that pleasure.

Figure out your triggers. It is much easier to avoid temptation than to resist it. If you know what triggers a particular habit, sometimes you can get rid of that habit simply by removing that trigger from your life. For example, Billi realized he was watching too much television, and the trigger was seeing the television set itself. So he moved it out of his bedroom, and now he doesn’t have a problem watching too much television. As another example, if you don’t want to buy cookies, don’t walk down the cookie aisle at the supermarket. Seeing all those delicious baked goods will release dopamine and push you toward buying them.

It becomes even more problematic in depression, because there’s less dopamine activity in the nucleus accumbens. First, that means things that used to be enjoyable no longer are. Second, with reduced dopamine activity, the only things that motivate the nucleus accumbens are things that release lots of dopamine, such as junk food, drugs, gambling, and porn.

Routines often cause downward spirals because we act them out even though we don’t derive any pleasure from them. On top of that, we’re often unaware when we’ve initiated them.

That’s why you never forget how to ride a bike. This is one of the reasons that bad habits are so hard to change. You don’t actually eliminate old habits—they just get weaker as you create newer, stronger ones. Furthermore, once habits are in the dorsal striatum, they no longer care about pleasure. Sure, they usually first get in there because your nucleus accumbens is motivating you to do something, but once a habit is really engrained, it no longer requires the nucleus accumbens to motivate it.

That’s also how addictions work. Addictions start out as pleasurable impulses in the nucleus accumbens. But over time, the nucleus accumbens stops responding, and the addictions no longer feel pleasurable. But because they are engrained in the dorsal striatum, you feel compelled to have another drink or another cigarette anyway.

The alarm goes off on your bedside table, startling you awake, but you’re not sure if you have the energy to turn it off. Many people wake up sluggish, but in depression, that same feeling can last the whole day—your energy drains away, and everything feels difficult. Fatigue is a common symptom of depression and is due both to the prefrontal dysfunction that we already discussed—such as reduced serotonin, which makes planning and decision making sluggish—and reduced activity in the dorsal striatum.1

In chapter 2, we learned that coping is the third part in the ABCs of anxiety. But coping doesn’t just happen when you’re anxious—it’s a habit that helps us deal with any form of stress. Stress causes dopamine release in the dorsal striatum,2 which automatically activates your coping habits.

Your oldest habits are probably the ones that used to distract you from life’s greatest stresses, but now that your life situation has changed, they’re no longer helpful. And yet you still do them, because they’re there.

But it’s not impossible. To get rid of a destructive coping habit, you can’t just stop doing it, because then you’re left with the stress. Instead, you have to replace it with another habit.

He also took measures to reduce the stress that triggered his bad habits, mainly through exercise, writing, and mindfulness.

Our coping habits are not the only habits triggered by stress. In fact, stress biases the brain toward any of our old habits over new actions.3 The dorsal striatum says, “Let’s do it this way, because we’ve always done it this way.” And the prefrontal cortex says,

When stressed, you usually act out your most deeply engrained routines or become a victim to your impulses.

Take a deep breath. When you start to feel antsy or compelled to act on a bad habit, take a deep breath. Let it out slowly, then take another deep breath. Repeat as necessary. As we’ll discuss more in chapter 9, long, slow breathing calms the brain’s stress response.

If you can remove the trigger from your life (for example, avoiding a bar if you’re an alcoholic), you can evade the habit.

Willful actions are enacted by the prefrontal cortex, and inhibiting impulses requires proper serotonin function in the prefrontal cortex.

Resisting impulses is like fighting an army of zombies with a limited number of bullets. Eventually you’ll run out.

Another solution is to make inhibiting your bad impulses and routines pleasurable in itself—and that becomes possible if you’re inspired by a goal.

And it’s pretty amazing that it’s possible—no matter how old you are, you still have the power to change your brain and improve your life.

Depression is so hard to overcome because each circuit pulls the others downward. But there’s good news. Your brain is not set in stone. Life changes cause brain changes—you can willfully change the activity, chemistry, and wiring of the regions and circuits in your brain that lead to depression.