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

by Alex Korb

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.

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.

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.

the striatum, unlike the prefrontal cortex, is not rational, at least not in the way you usually define “rational.” It doesn’t distinguish between good and bad habits at all. The striatum is perfectly happy carrying out bad habit after bad habit with no regard to the long-term consequences.

Bad habits can generally be classified as either impulses or routines. Impulses are actions driven by a momentary desire,

Impulses and routines are both controlled by the striatum, but routines rely on the upper part,

Both regions rely heavily

on the neurotransmitter dopamine, an important fact we...

The nucleus accumbens chooses what to do based on what’s the most immediately pleasurable. And the dorsal striatum chooses what to do based on what we’ve done 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.

Sex releases dopamine. Winning money releases dopamine. Drugs release dopamine. Chocolate releases dopamine.

With impulses, something you do or sense triggers the anticipation of a specific pleasurable outcome. The problem is that the dopamine that is released in anticipation of pleasure actually motivates the actions that lead to that pleasure.

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.

there are too many easily obtainable pleasures, which hijack dopamine in the nucleus accumbens and create a tendency to act for immediate gratification.

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.

And while most impulses are easy to recognize, the most insidious bad habits are often routines.

“For the first thirty years of your life you make your habits. For the last thirty years of your life, your habits make you.”

Routines often cause downward spirals because we act them out even though we don’t derive any pleasure from them.

The dorsal striatum has many strong ties to the nucleus accumbens, and it also utilizes dopamine. However, the dopamine released in the dorsal striatum doesn’t make you feel pleasure; it just compels you to act.

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.

Because of these changes in dopamine, addictions increase your risk of developing depression, and depression increases your risk of developing an addiction. Another downward spiral.

Unfortunately, sometimes the problem lies not in bad habits, but in doing nothing at all.

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,

Proper prefrontal functioning is required to create new actions, so when the prefrontal cortex is disrupted, it lets the striatum take over.

But coping doesn’t just happen when you’re anxious—it’s

Stress causes dopamine release in the dorsal striatum,2 which automatically activates your coping habits.

Everyone has coping habits; they are some of the deepest, most ingrained routines we have. They make us feel better, at least for the time being, by reducing amygdala activity and the body’s stress response.

But bad coping habits don’t stabilize your mood in the long term, so acting them out just creates more stress later on,

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.

This is the case with all addictions: if you don’t act on your habit, you feel anxious, which makes you want to act on the habit even more. And if you do yield to the habit, it just causes more stress later on, which retriggers the habit. It’s easy to see how we get stuck in a cycle—how it can feel impossible to break out of.

To get rid of a destructive coping habit, you can’t just stop doing it, because then you’re left with the stress.

you have to replace it with an...

but it’s achievable with more constructive coping habits and reducing stress in the brain—which we’ll delve into in the second half of this book.

Stress changes the dynamics of the conversation. When you’re calm and relaxed, your prefrontal cortex is pretty good at getting its way. But the more anxious or stressed you get, the more the power shifts to the dorsal striatum and nucleus accumbens.

all bad habits are triggered by something. If you can remove the trigger from your life (for example, avoiding a bar if you’re an alcoholic), you can evade the habit. Unfortunately, triggering the habit is often unavoidable. For one thing, many habits are triggered by stress, and nobody lives a totally stress-free life.

to overcome that through willful action. In this case, “willful” means we consciously and deliberately “put on the brakes” to stop acting out a habit. Willful actions are enacted by the prefrontal cortex, and inhibiting impulses requires proper serotonin function in the prefrontal cortex.

You can create better habits, so that you don’t have to rely on the prefrontal cortex, and you can boost your serotonin activity;

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. Setting goals changes the activity in multiple brain regions, including the nucleus accumbens, prefrontal cortex, and anterior cingulate.

Ultimately, it comes down to the most clichéd but scientifically true maxim: practice, practice, practice. To create new, good habits, you have to repeat them over and over again until your brain rewires itself. At the end of the day, repeating act...

Understanding is powerful in itself, because knowing what’s going on creates a better sense of control. Understanding also provides a step toward acceptance, and until you accept how things are now, it is difficult, if not impossible, to change.

You don’t have to change your life in all these areas to see a benefit; each small change in one area will benefit the others.

When you don’t think of it as “exercise” but rather as “being active” or “having fun,” you’re more likely to do it, and it will have a bigger emotional benefit.

Exercise is possibly the most straightforward and powerful way to start an upward spiral. Not only is it easy to understand, but exercise also has many of the same effects on the brain as antidepressant medications and even mimics the buzz of recreational drugs. Yet exercise is natural, it causes more nuanced and targeted brain changes, and its benefits can exceed even those of medication.

To overcome depression, your brain needs to get off its lazy butt, and you’ve got to make it.

I’m calling your brain lazy. But at the end of the day, you’re the one who can do something about it.

Do it with someone else. Not only is social interaction g...

gives you more energy and vitality.

improves your sleep, making it more restorative for your brain (chapter 7).

Exercise improves your appetite, leading to more enjoyable eating and better health.

exercise makes you mentally sharper and better at planning and decision making.2