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

by Alex Korb

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.

Many people just notice physical symptoms and don’t recognize that it’s anxiety. If you have shortness of breath, dizziness, muscle tension, an upset stomach, chest pain, or just a general feeling of dread, it might be anxiety.

nonjudgmental awareness—the process of being aware of the present, without attaching emotional reactivity to it.

This attention circuit is influenced by the emotion circuit, so our brains are wired to pay more attention to emotional events.

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.

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.

Thus, exercise has an effect on the brain similar to that of antidepressants.

Exercise helps create the conditions for growth, but you’ve got to keep it up and give it time to work.

The difficulties with concentration and deep thinking that often accompany depression are mainly the fault of a lagging norepinephrine system, which is why, next to serotonin, norepinephrine’s the neurotransmitter most commonly targeted by antidepressant medications. Fortunately, exercise increases norepinephrine as well.

The orbitofrontal cortex influences motivation and decision making. The dorsolateral prefrontal cortex helps with planning and thinking. The insula modulates pain perception. And the anterior cingulate guides your focus. Amazingly, endorphin signaling in all of these areas is improved by exercise.

In general, the prefrontal cortex is responsible for goal-directed behavior. That means it decides what goals to achieve and how to achieve them, and the first step to achieving goals is all about making decisions.

We’ve all heard the idea that we use only 10 percent of our brains…and it’s a big fat lie. Everyone uses their whole brain, although when your brain is processing too many irrelevancies, it loses power to process the things that are most important to you.

Decision making in the prefrontal cortex, which is a high-level brain process, affects the lower-level sensory processes.

Making a decision, even a tiny decision, starts shedding light on ways to improve your life.

We are often under the impression that we are happy when good things happen to us. But in actuality, we are happiest when we decide to pursue a particular goal and then achieve it.

Creating specific, meaningful, and achievable long-term goals can be a powerful way to reverse the course of depression.

Obviously, exercise itself is important, as we covered in the last chapter, 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 increase your confidence, mood, and future decision-making capabilities.

When your prefrontal cortex has to loop through many potential scenarios, it increases the risk of triggering anxiety or worry.

Instead, just start doing something productive—anything productive—even if it’s not the thing you’re supposed to be doing. Wash one dish in the sink. Put on your shoes. Send one work email.

Once you start being productive, dopamine is released in the striatum and parts of the prefrontal cortex. Suddenly you’ll have more energy and motivation to do the thing you really need to do.

biofeedback, which is simply the fact that the brain changes its activity based on what the body is doing.

Try yoga. Yoga utilizes almost every suggestion in this chapter, including stretching, breathing, relaxation, and posture changes, and it can, in fact, help treat depression.1 Yoga poses that incorporate back bends and opening the chest do a particularly good job at increasing positive emotions.

A study from Sweden showed that a combination of different breathing types (slow, fast, and superfast) increases feelings of optimism and decreases feelings of depression, anxiety, and overall stress.

Sometimes you feel that you need more energy. Try quick, shallow breaths for twenty to thirty seconds.

The drive to change your current circumstances is most likely mediated by serotonin, because without adequate serotonin function, people tend to become resigned to their fates.

Take a few minutes every day to write down three things you’re grateful for.

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.

Remembering to be grateful is a form of emotional intelligence.

With gratitude, it is often the searching, the looking, the fishing for gratitude that activates the circuitry.

If you start to feel your mood sliding downhill, try going somewhere where there are other people around, like a library or coffee shop. You don’t need to interact with others; just being in the same physical space can help.

Humans are a social species—we evolved to survive with each other, and our brains are healthiest when we interact with and feel connected to others. That means that when we feel disconnected, the consequences can be devastating.

The poet Emily Dickinson once wrote, “It might be lonelier without the loneliness.” She famously kept to herself and yet was scared of being alone.

Importantly, if you’re having difficulty being happy, it can be easier to absorb feelings of happiness from others than to generate them in yourself.

Because it can be scary when you first start reaching out to people, seeing a therapist can help

Find a community where you feel like you belong—a church, a team, or an activity group. Keep seeking interactions with others, and be patient with yourself—allow your brain time to rewire.

For some people, a little exercise goes a long way. For others, simply changing sleep patterns can work wonders. Some people need Prozac; others need Wellbutrin. It all depends on the unique tuning of your neural circuits. You can’t really know which kind of brain you have until you give it a try.

Feeling better is simply a combination of finding the right life changes for you to create the right brain changes.

And interestingly, when you’re stewing in negative emotions, accepting them often helps them dissipate,

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.

You also understand the contributions of the different neurotransmitters. Serotonin helps with impulse control, willpower, and resilience. Dopamine is important in enjoyment and habits. Norepinephrine modulates focus and concentration. Oxytocin is essential to close relationships. Other neurotransmitters are important too, like GABA (antianxiety), endorphins (elation and pain relief), and endocannabinoids (appetite and peacefulness). Other chemicals, like BDNF, help grow new neurons, and even proteins in the immune system play a role. The whole chemical milieu is as complicated and intertwined as international economics.

Everything is interconnected. Gratitude improves sleep. Sleep reduces pain. Reduced pain improves your mood. Improved mood reduces anxiety, which improves focus and planning. Focus and planning help with decision making. Decision making further reduces anxiety and improves enjoyment. Enjoyment gives you more to be grateful for, which keeps that loop of the upward spiral going. Enjoy...