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

by Alex Korb

The big problem with the downward spiral of depression is that it doesn’t just get you down, it keeps you down.

relatively few. Two parts of the brain in particular are to blame: the prefrontal cortex and the limbic system. To simplify, the prefrontal cortex is basically the thinking part of the brain, and the limbic system is the feeling part. In depression, something is off with the way these

Serotonin—improves willpower, motivation, and mood Norepinephrine—enhances thinking, focus, and dealing with stress Dopamine—increases enjoyment and is necessary for changing bad habits Oxytocin—promotes feelings of trust, love, and connection, and reduces anxiety GABA—increases feelings of relaxation and reduces anxiety Melatonin—enhances the quality of sleep Endorphins—provide pain relief and feelings of elation Endocannabinoids—improve your appetite and increase feelings of peacefulness and well-being

Each quadrant of the prefrontal cortex is primarily responsible for a different group of functions. The medial parts are more self-focused, while the lateral parts are more focused on the outside world. Along the vertical dimension, the ventral parts are more emotional, while the dorsal parts are focused more on thinking. Thus the primary distinction in the prefrontal cortex is between dorsolateral and ventromedial

It is primarily composed of four regions: the hypothalamus, the amygdala, the hippocampus, and the cingulate cortex. 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.

The hypothalamus regulates numerous hormones and controls the body’s stress response.

Anxiety is primarily mediated by the amygdala, an ancient structure deep in the brain, which is closely connected to the hypothalamus

The primary job of the hippocampus is turning short-term memories into long-term ones,

However, the hippocampus does much more. It is also central to context-dependent memory, which is the fact that it’s easier to remember things that relate closely to your current situation.5

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.

Think of happy memories. Happy memories boost serotonin in the anterior cingulate (chapter 8). Try to think of one happy memory before you go to sleep—write it in a journal or just reflect on it.

it works!

The striatum has two main parts that are particularly important in depression: the upper part, known simply as the dorsal striatum, and the lower part, called the nucleus accumbens.

The dorsal striatum is the brain’s habit circuit; it controls most of your good and bad habits.

the nucleus accumbens is the “partier” of the brain.

Dopamine is released in the nucleus accumbens whenever you do anything fun and exciting—or at least it’s supposed to.

The insula is part of the cortex that folds inward a couple inches from your ears, sitting close to the amygdala and hippocampus. It’s one of the main regions in the pain circuit and contributes more generally to bodily awareness.

Lastly,

five factors: - genetic - childhood - context - social support - luck

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

Como lo hace? toma decisiones porque es ansiosa mide automáticamente los alimentos no planea no mira el dinero

Worrying involves the prefrontal cortex and its interactions with the limbic system, particularly the anterior cingulate, while anxiety involves only the limbic system, mostly interactions between the amygdala, hippocampus, and hypothalamus. In essence, worrying is thinking about a potential problem, and anxiety is feeling it.

Take a deep breath. Taking a slow, deep breath—inhaling and then exhaling slowly—actually calms down the sympathetic nervous system and reduces stress

Go for good enough. Worrying is often triggered by wanting to make the perfect choice or by trying to maximize everything.

The first step is simply to recognize your anxiety or worrying when it occurs. Becoming aware of your emotional state activates the prefrontal cortex and allows it to suppress the amygdala.

Stay in the now. Pay attention to the things that are happening now, and don’t pay attention to the things that aren’t happening now. Focusing on the present helps reduce anxiety

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.

try practicing nonjudgmental awareness. Nonjudgmental awareness is a form of mindfulness that simply means noticing without reacting emotionally,

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

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

Two neurotransmitter systems play a particularly important role in reversing the negative bias: serotonin and 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.

combat pessimism, you can strengthen the brain circuits responsible for optimism. The first step is to simply imagine the possibility of positive future

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,

Impulses and routines are both controlled by the striatum, but routines rely on the upper part, the dorsal striatum, while impulses are initiated by the lower part, the nucleus accumbens. Both regions rely heavily on the neurotransmitter dopamine,

The really interesting thing about the nucleus accumbens, however, is that it learns what’s pleasurable and how to anticipate getting it. For example, when you eat a Snickers for the first time, dopamine is released in the nucleus accumbens. The next time you pick up a Snickers, dopamine is released as soon as you open the wrapper. And the next time, dopamine is released simply when you see the Snickers from across the room. Pretty soon, dopamine is released as soon as you walk into the store, just from the anticipation of seeing it, opening it, and eating it.

Figure out your triggers. It is much easier to avoid temptation than to resist it.

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. Habits are formed because every action activates a specific pattern in the dorsal striatum. Each time you follow the same path, it becomes more and more defined in your brain—in

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.

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.

Gratitude Boosts Serotonin One powerful effect of gratitude is that it can boost serotonin. Trying to think of things to be grateful for forces you to focus on the positive

With optimism, you don’t even have to believe good things will happen; you just have to believe that they could happen or that no matter what happens, you’ll be okay.

Be grateful when you wake up.

Humor Appreciation

An old Cherokee legend tells of a battle between two wolves. One wolf represents anger, jealousy, self-pity, sorrow, guilt, and resentment. The other stands for joy, peace, love, hope, kindness, and truth. It is a battle raging inside us all. Which wolf wins? The one you feed.

The Difference Between Fishing and Catching

Be around people.

In depression, oxytocin isn’t always released when it should be, and it’s sometimes released when it shouldn’t.5 In addition, the brain’s response to oxytocin isn’t always on target.

Friends, Family, and Strangers Improve Your Mood

Being around other people and developing close relationships feels good for a reason, and that reason is dopamine.

Dopamine neurons connect to the part of the hypothalamus where oxytocin is produced,28 and oxytocin stimulates the area of the brain stem where dopamine is produced. In addition, the dopamine-rich nucleus accumbens receives input from oxytocin neurons.

Turn up the heat.

you can’t get a hug, try wrapping yourself in a blanket and holding a mug of hot tea. Taking a warm shower