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

by Alex Korb

Depression is a very stable state—your brain tends to think and act in ways that keep you depressed.

Each electrical pulse—and resulting squirt of neurotransmitter—is not an order commanding the next neuron’s actions; it is more like a vote on what the next neuron should do.

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

A dysfunctional serotonin system is responsible for the lack of willpower and motivation. The difficulty in concentration and thinking is probably due to problems with norepinephrine. Dysfunction in the dopamine system leads to bad habits and lack of enjoyment.

hypothalamus, the amygdala, the hippocampus, and the cingulate cortex.

Try to think of one happy memory before you go to sleep—write it in a journal or just reflect on it.

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.

when finishing grad school, I knew I needed to look for a job, but nothing seemed interesting, and I didn’t want to get stuck in a job that wasn’t interesting. I could go work for a big company, but was that selling out? And would I really find it meaningful? I could work for a start-up, but then what if that was too time consuming, and I didn’t have time for fun? And what if it failed? Maybe I could teach, but would I make enough money to support a family someday? And where would I find a good teaching job? Maybe I could do something else entirely, but everyone would think I was stupid for wasting all this time on a PhD.

many people are less happy when they have more choices, because they have more to worry about.1

worrying is thinking about a potential problem, and anxiety is feeling

Sometimes it seems like the whole world is conspiring against you, like life is full of disappointing events, missed opportunities, and harsh circumstances. Maybe, for you, it feels that way all the time. But guess what? It’s not some cosmic conspiracy, just a by-product of your brain circuitry.

suggest that we experience negative events more personally and we feel them more deeply.

We need three positive comments from a friend for every negative one, three wins at work for every loss.

children of depressed parents have a higher chance of developing depression for many reasons, including genetics, early childhood experiences, and learned behaviors.

Your brain does not live in a jar, disconnected from the world. It is interconnected with your body, so the things you do with your body affect your neurochemistry. Your brain does not like being idle; it comes with a body, and it wants to use it.

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

when rats are exposed to uncontrollable stress, if they are given the choice to run on an exercise wheel, they don’t suffer negative consequences.19 Interestingly, if they are forced to exercise, they don’t get the same benefits, because without choice, the exercise is itself a source of stress.

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

“poor sleep,” I mean getting not only too little sleep but also getting low-quality sleep. 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.

standing or sitting in an open, expansive posture increases testosterone and decreases the stress hormone cortisol.14

Botox is a neurotoxin that removes wrinkles by paralyzing certain facial muscles. Paralyzing the corrugator supercilli makes it very difficult to create a furrowed brow, and people who have had that treatment often experience less anxiety simply because they can’t create the corresponding facial expression.

studies show that comparing yourself to the less fortunate does not have the same benefits as gratitude.17

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 can change dopamine and the dorsal striatum with exercise. You can boost serotonin with a massage. You can make decisions and set goals to activate the ventromedial prefrontal cortex. You can reduce amygdala activity with a hug and increase anterior cingulate activity with gratitude. You can enhance prefrontal norepinephrine with sleep.