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

by Alex Korb

And most importantly, achieving the goal is often less important to happiness than setting the goal in the first place.13

If you have found some specific, meaningful goals, do you believe you can achieve any of them? If not, break them down into smaller goals that you believe may be achievable.

but it means that the prefrontal cortex is able to modulate your habits and impulses. That gives you more control over your own life so that you’re not controlled solely by your past experiences or current environment.

There’s nothing wrong with being on autopilot and letting the habits in the dorsal striatum take over, as long as you first make sure you’re headed in the right direction.

You may not make all the right decisions, but they will be your decisions.

Indecisiveness is part of the downward spiral because it enhances your feeling of being out of control.

after the experiment, rat A ends up pretty well off, but rat B develops symptoms of depression. And in fact, rat B, who had no control,

The amount that you feel in control of a situation lowers your stress level.

Having control over the shock reduced the amount of reactivity in brain pain circuits,18 and it increased activity in the dorsolateral prefrontal cortex and anterior cingulate.

This means that using decision making to increase medial prefrontal activity seems like a good idea.

As long as you have control over something, you can take advantage of the benefits.

if they are forced to exercise, they don’t get the same benefits, because without choice, the exercise is itself a source of stress.20

but deciding to exercise is also a powerful way to start an upward spiral.

The important thing here is not actual control, but perceived control. Making decisions may not increase your actual control over a situation, but it will likely increase your perceived control. And when you increase your perceived control, you incre...

When you decide on one path, then you’ve reduced the number of variables the prefrontal cortex needs to optimize.

A decision is simply creating an intention to move in a particular direction. It doesn’t mean that you need to go that direction forever.

Even if your initial decision turns out to be wrong, you’re still in control of your life.

This study shows that working to reduce your focus on negative outcomes can help with decisiveness. But it also shows that simply picking a path has the same effect.

you don’t have to start with the big decisions. You can start small. Choose

Similarly, every time you make a decision instead of procrastinating, worrying, or acting impulsively, you

strengthen your decision-making circuit for the future.

Just like with exercise, you’re training your brain for the future,

you’ll have set the stage for an upward spiral.

Poor sleep is one of the most common symptoms of depression, as well as one of the biggest contributors to developing depression and staying depressed.

Mentally, poor sleep worsens your mood, lowers your pain threshold, and interferes with learning and memory. It also diminishes your ability to concentrate and makes you more impulsive. Physically, it increases blood pressure, elevates stress, and harms the immune system. It can even cause weight gain.

Fortunately, several large recent studies have shown that it is possible to greatly improve your sleep, which can dramatically relieve depression or even prevent it in the first place.

The key for improving your sleep comes down to two main factors: dealing with your anxieties and stress and improving your sleep hygiene.

Most problems with sleep are exacerbated by poor sleep hygiene, and some are caused entirely by it.

Furthermore, your sleep needs change over the course of your

lifetime—just

If you have any problems with sleep, they can most often be fixed with changes in sleep hygiene.

is your brain’s internal clock—its circadian rhythms—which controls a variety of hormones and neurotransmitters on a daily cycle. If you can understand sleep architecture and circadian rhythms, you’ll have a pretty good understanding of how sleep affects the brain.

sleep has an intricate architecture that is affected by our waking lives. And in a great example of an upward spiral, the quality of our sleep in turn affects our quality of life.

The misperception of having lain there awake the whole time adds to their distress.

After about five to ten minutes of stage 1 sleep, your brain goes deeper, into stage 2, then over the next hour, it progresses deeper into stages 3 and 4, in which your brain’s electrical activity slows down dramatically. Because of the dramatic slowing, stages 3 and 4 are often called slow-wave sleep.

After slow-wave sleep comes REM sleep, in which your brain is a lot more active. As I mentioned in chapter 5, people with depression show increased amounts of REM sleep,2 and they spend less time in slow-wave sleep, which means their sleep is less restful. One...

So if you don’t sleep continuously, the proper progression is disrupted, and your sleep is less restorative. Interestingly, if you wake up during stage 1, you feel a lot more rested than if you are disturbed in other stages.