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

by Alex Korb

The hypothalamus controls stress. The amygdala is the key to reducing anxiety, fear, and other negative emotions. The hippocampus is responsible for creating long-term memories, and because its neurons are very sensitive to stress, it often acts as the canary in the coal mine of depression. Lastly, the cingulate cortex controls focus and attention, which is of huge importance in depression, because what you focus on, whether by automatic habit or willful choice, makes a huge difference to your mood. Stress and the Hypothalamus Feeling tense? On edge? Elevated stress is both a cause and a symptom of depression, and it can be attributed to the hypothalamus in the central limbic region. The hypothalamus regulates numerous hormones and controls the body’s stress response. It can send your body into fight-or-flight mode, raising stress hormones like cortisol and adrenaline. It’s like a military base waiting to deploy troops to deal with threats. When you’re depressed, it’s a base on high alert—it has a hair-trigger response, making it difficult to relax and just be happy. Finding ways to calm the hypothalamus is therefore one of the best ways to reduce stress.

Difficulty concentrating is another symptom of depression, as is a greater focus on the negative, both of which are mediated by the cingulate cortex. In particular, the front of the cingulate—the anterior cingulate—has the biggest impact on depression.

These bad habits are primarily caused by disrupted activity in the striatum, which is an ancient subcortical region deep below the surface that we inherited from the dinosaurs.

People with depression are more likely to suffer from chronic pain and tend to worry more about getting sick. These symptoms arise from an increased awareness of bodily sensations, which is mediated by the insula.

So if you tend to worry, reduce your options and make quick decisions whenever possible. As soon as you make a decision, however small, everything starts to feel more manageable—we’ll

confirmed

Planning your response to stressful situations can increase prefrontal norepinephrine, and calm the limbic system, helping you feel more in control.

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

The important thing to understand about a pattern in the dorsal striatum is that once it’s there, it’s pretty much there for good. 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.

The dorsal striatum doesn’t care about what you want. It just cares about following paths that you’ve already carved out. Understanding the paths your brain follows is a key step to change. Unfortunately, sometimes the problem lies not in bad habits, but in doing nothing at all.

In the beginning, it was just an impulse to eat, but eventually it became deeply ingrained as a routine. Once a routine, pleasure was no longer a part of it, nor was attention, but it still provided a sense of control in a crazy world. It became an addiction.

Acceptance, on the other hand, teaches that how you feel is simply how you feel. It’s neither good nor bad. It just is. And interestingly, when you’re stewing in negative emotions, accepting them often helps them dissipate, like an early morning mist beneath a ray of sun.

You know that depression is a dysfunction in frontal-limbic communication. You know that the prefrontal cortex helps manage your emotions and desires so that you can plan for the future. The dorsal striatum acts out old habits, and the nucleus accumbens controls enjoyment and impulses. The anterior cingulate manages attention to the negative or the positive, and the insula is responsible for emotional sensations. The amygdala mediates anxiety. The hypothalamus regulates numerous hormones and controls the stress response. The hippocampus is closely tied to the amygdala and hypothalamus and is essential to learning and memory.