In “The Upward Spiral” Alex Korb shows us how to use neuroscience to reverse the course of depression. Packed with practical tips this book can serve as a vital part of a mental health strategy. It even inspired the creation of my ebook “The Definitive Guide to Defeating Depression”.
-Sometimes everything just feels difficult and pointless. It’s a feeling we all get from time to time, and it’s simply a natural byproduct of our complex brain circuitry. And for most people, it’s just a fleeting feeling, gone like a whisper. But due to slight differences in neurobiology, some people get stuck.
-Downward spirals occur because the events that happen to you and the decisions you make change your brain activity. If your brain activity changes for the worse, it contributes to everything snowballing out of control.
-Depression generally involves a problem with how the thinking and feeling circuits in the brain get out of whack.
-The prefrontal cortex is the thinking part of the brain, and the limbic system is the feeling part. In depression, something is off with the way these regions act and communicate with each other. The thinking prefrontal cortex is supposed to help regulate the feeling limbic system, but it’s not doing a good job.
-It only takes a few positive emotions to kick-start an upward spiral
Chapter 1 – A Brain Map of Depression
-In depression, there’s nothing fundamentally wrong with the brain. It’s simply that the particular tuning of the neural circuits creates the tendency toward a pattern of depression.
-Everyone has depressive tendencies to a varying degree
-Your brain is composed of billions of neurons, tiny nerve cells.
-Neurons are constantly talking to each other by firing electrical pulses down their long branches. When an electrical pulse reaches the end of a branch, the neuron squirts out a chemical signal, a neurotransmitter.
-Neurotransmitters transmit information by floating into the space between the neurons – the synapse — and binding to the next neuron.
-Each electrical pulse — and a resulting squirt of neurotransmitter – is like a vote on what the next neuron should do.
-By changing the firing rate of neurons in a few key regions, you can influence the pattern of activity in the entire brain.
-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
-This is an oversimplification, but in general, each neurotransmitter contributes to a different depressive symptom. A dysfunctional serotonin system is responsible for a 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.
-Depression is not just a manner of a chemical in-balance. But increasing levels of some of these neurotransmitters is part of the solution.
-Our big prefrontal cortex gives us a huge evolutionary advantage, but it can also cause problems. In depression, it is responsible for worrying, guilt, shame, problems with thinking clearly, and indecisiveness.
-The ventromedial prefrontal cortex thinks about emotions, while the limbic system feels them.
-People with depression often have higher amygdala reactivity, so reducing that can help lower anxiety and relieve depression.
-Context-dependent memory states that it’s easier to remember things that relate closely to your current situation.
-Because the “context” is depression, all those happy memories that are easy to recall when you’re in a good mood suddenly evaporate. Meanwhile, all the tragedies in your life become too easy to remember.
-Depression is often accompanied by bad habits such as impulsiveness, poor coping skills, addiction, and procrastination.
-Difficult concentrating is another symptom of depression
-The small hippocampus is likely the result of chronic stress, which can damage and kill neurons. Depression is stressful and thus disrupts the proper functioning if the hippocampus.
-The specific tuning of your decision making circuit can contribute to your brain getting stuck in depression — as can the specific tuning of your habit circuit, your stress circuit, your social circuit, your memory circuit. They can all potentially contribute to a downward spiral of depression, when the conditions are right.
-Your early childhood depression experiences, current life stress, and level of social support can influence your circuitry toward or away from depression.
-Your genes aren’t your destiny but they can influence the development of certain circuits and increase your risk for depression.
-Happy memories boost serotonin in the anterior cingulate
-Close relationships help protect against depression
-It’s not the number of friends you have that matters, but the quality of those relationships.
Chapter 2 – Trapped with Anxiety and Worry
-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.
-When you’re in a negative mood, almost all outcomes that your prefrontal cortex can calculate are tinged with a bit of negativity.
-Worrying is mostly thought based, whereas anxiety has more to do with physical components like bodily sensations (such as an upset stomach) or associated actions (like avoiding a situation).
-Worrying is thinking about a potential problem, and anxiety is feeling it.
-Pay attention to what you CAN control to reduce anxiety
-Fear comes from seeing a lion jump out of the grass and start running toward you. Anxiety comes from seeing the grass rustle and assuming that a lion is hiding there.
-“Maximizing” has been proven to increase depression. So don’t try to make the most amazing dinner; start out by just making a good dinner. Don’t try to be the perfect parent; just be a good one. Don’t try to be your happiest; just be happy.
-Anxiety is exacerbated by envisioning the worst possible scenario — a process known as “catastrophizing”
-Pay attention to the things that are happening NOW helps reduce anxiety and worry, because it decreases emotional, self-focused processing in the ventromedial prefrontal cortex.
Chapter 3 – Always Noticing the Negative
-The attention circuit is influenced by the emotion circuit, so our brains are wired to pay more attention to emotional events.
-The brain’s inherent emotionality is exaggerated in depression. For example, one study showed that people with greater depressive symptoms, as well as those at risk for depression, were more likely to interpret neutral facial expressions as being sad.
-All of our brains react more strongly to negative events
-On average we need 3 positive comments for every negative one
-Daughter of depressed mothers had a greater bias toward noticing negative facial expressions
-One version of the gene that encodes for the serotonin transporter molecule significantly increases your likelihood of developing depression. People with this copy of the gene have brains that pay more attention to negative emotions and less attention to positive ones.
-Mood congruent attentional bias states that moods change perception of reality
-Practice Nonjudgmental awareness which means noticing without reacting emotionally, even when things don’t turn out as you expected.
-Noticing a mistake might automatically trigger the emotional amygdala, but becoming aware of your own reaction activates the prefrontal cortex, which calms the amygdala.
-The anterior cingulate is on by default. It’s always looking over your shoulder watching for mistakes.
-Some people have a lower threshold for uncertainty and label it as bad although it is unknown
-A hug, especially a long one, releases a neurotransmitter and hormone called oxytocin, which reduces the reactivity of the amygdala.
-Depressed people are more likely to perceive pain as more painful
-Two neurotransmitter systems play a particularly important role in reversing the negative bias: serotonin and norepinephrine.
-Surprisingly simple things can increase norepinephrine such as exercise, a good night’s sleep, and even getting a massage.
-Admitting the possibility of good things helps control the brain’s negative bias.
-Another way to strengthen optimism circuits is not just recognizing that good things could happen, but expecting that they will happen.
Chapter 4 – Caught in Bad Habits
-The actions you take are the result of a conversation between the prefrontal cortex, nucleus accumbens, and dorsal striatum. The prefrontal Cortex choose what to based on what’s the most immediately pleasurable. And the dorsal striatum chooses what to do based on what we’ve done before.
-The prefrontal cortex is the only part of the circuit that cares about your long-term well-being, but unfortunately, it often gets outvoted.
-The nucleus accumbens learns what is pleasurable and how to anticipate getting it
-The first time you eat a snickers dopamine is released in the nucleus accumbens. The next time you pickup 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.
-The problem is that the dopamine that is released in anticipation of pleasure actually motivates the actions that lead to that pleasure. Each step along the way gives you a little boost of dopamine that propels you on to the next step.
-“For the first thirty years of your life you make your habits. For the last thirty years of your life, your habits make you.”
-Each time you follow the same path, it becomes more and more defined in your brain — in other words, the neurons in the dorsal striatum are wired together more strongly.
-Once a pattern is established in the dorsal striatum it is pretty much there for good. This is why you never forget how to ride a bike.
-You don’t actually eliminate old habits — they just get weaker as you create newer, stronger ones.
-Everyone has coping habits; they are some of the deepest, most ingrained routines we have.
-Good coping habits can pull you out of an impending downward spiral, because the dorsal striatum takes over and sets your life back on course.
-But bad coping habits don’t stabilize your mood in the long term, so acting them out creates more stress later on, and down the rabbit hole you go.
-The case of all addictions: if you don’t act on your habit, you feel anxious, which makes you want to act on the habit even more.
-To get rid of a destructive coping habit, you can’t just stop doing it, because then you’re left with the stress. Instead, you have to replace it with another habit.
-When you’re calm and relaxed, your prefrontal cortex is pretty good at getting its way. But the more anxious or stressed you get, the more the power shifts to the dorsal striatum and nucleus accumbens.
-Willful actions are enacted by the prefrontal cortex, and inhibiting impulses requires proper serotonin function in the prefrontal cortex.
Part 2 – Creating an Upward Spiral
Chapter 5 – Exercise Your brain
-Your brain does not like being idle; it comes with a body, and it wants to use it.
-Exercise increases brain derives neurotrophic factor (BDNF), which are like steroids for your brain.
-Exercise causes growth of new neurons
-Movement increases the firing rate of serotonin neurons, which causes them to release more serotonin.
-Exercise increases norepinephrine But Intense exercise increases it more
-Exercise causes your brain to release endorphins, neurotransmitter that act on your neurons like opiates by sending a neural signal to reduce pain and provide anxiety relief. (Runners high)
-Endorphin release is highest during intense exercise
-Excercise also increases activation of the endocannabinoid system
Chapter 6 – Set Goals, Make Decisions
-Making decisions includes creating intentions and setting goals — all three are part of the same neural circuitry and engage the prefrontal cortex in a positive way, reducing worry and anxiety.
-Deciding on goal and then achieving it feels more rewarding than if something good happens to you by chance.
-Achieving the goal is often less important to happiness than setting the goal in the first place
-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.
Chapter 7 – Give your brain a rest
-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.
-Sleep hygiene is the combination of your actions and the environment that precedes sleep or potentially interferes with it, including your bedtime routine, or lack thereof, as well as the level of noise and light in your bedroom. It also includes the time you go to sleep and wake up, and the amount of light and exercise you get during the day.
-The quality of your sleep is also affected by daily chemical fluctuations called circadian rhythms
-Looking at bright lights after dark disrupt your circadian rhythm
-Circadian rhythm is also disrupted by changes in your bedtime
-Anything you can do to reduce planning or worrying before bedtime will help the quality of your sleep
-It helps to write your worries down to get them out of your head
-If you have insomnia, you’re more likely to develop depression, and vice versa. The connection between insomnia and depression probably has many causes, but one big culprit is communication between the prefrontal cortex and limbic system during sleep.
-When you have good sleep hygiene, your brain releases melatonin approximately thirty minutes before it’s planning to go to sleep. Melatonin release and sleep are both improved by exposure to sunlight.
-Our biggest increase in pain comes from disrupting sleep throughout the night. That means the most important factor is not the total amount of sleep, but the amount of continuous sleep.
Chapter 8 – Develop Positive Habits
-Habits are the things you do when you’re not thinking about what to do
-Self-affirmation or thinking about your good qualities helps you create positive habits. (positive memories boost serotonin)
-Stress biases the brain toward old habits over intentional actions, which is one of the reasons it is so hard to change coping habits.
-if you don’t use a coping habit you become more stress wanting to use the coping habit even more. The best solution is to find other ways to reduce your stress.
-You can reduce stress through exercise, decision making, improving sleep hygiene, biofeedback, gratitude and social interactions.
-Bright sunlight improves serotonin production and keeps the serotonin transporter from sucking it away (sunlight is a natural antidepressant)
-Massage boosts your serotonin by 30%
-Aerobic exercise boost serotonin production as well
-Remembering good memories boosts serotonin
-Suppressing an impulse can be rewarding if it’s in alignment with your long-term goals
-Getting things done and checking things off your to do list releases dopamine increasing to motivation to be more productive
Chapter 9 – Take advantage of Biofeedback
-In depression, people tend to inadvertently generate many negative types of biofeedback — for instance, a timid or withdrawn posture, usually accompanied by shoulders slouched down and forward, increases their feelings of sadness.
-Higher heart-rate variability is due to greater vagal tone
-You can initiate positive bio-feedback through laughing and smiling
-When you start to feel anxious or stressed or angry, notice if your brow is furrowed. Try relaxing your forehead, and it should help diminish the feeling.
-Slow breathing increases activity in the vagus nerve and pushes the brain toward parasympathetic activity.
-Breathe faster for energy
Chapter 10 – Activate a Gratitude Circuit
-Keep a gratitude journal can help you remember things you are grateful for
-Feeling gratitutude improves activity in your dopamine circuit and makes social interactions more enjoyable
-Gratitude can increase serotonin production
-Optimism combats negativity and is a form of gratitude because we are grateful for the possibility of good things to come
-Comparing yourself to the less fortunate is not the same as gratitude
-Gratitude is showing actual appreciation for the things you have
-It’s not finding gratitude that matters most; it’s remembering to look in the first place.
-Remembering to be grateful is a form of emotional intelligence.
Chapter 11 – Rely on the Power of Others
-Even though you may feel like being alone, the cure to depression often lies in other people.
-People with low self-esteem have even greater anterior cingulate activation, suggesting their brains are more sensitive to social rejection.
-In depression, oxytocin isn’t always released when it should be, and it’s sometimes released when ut shouldn’t.
-Interacting with others pushes the brain towards an upward spiral
-In one study participants had to put their hand into a bucket of ice water and hold it until the pain became overwhelming. Those who were accompanied by a friend or even a stranger experienced less pain.