The American psychiatrist Alex Korb in his “The upward spiral” (2015; literally “Spiral upwards”) combines useful information and practical tools to improve one’s life, starting from the knowledge of how our mind works. The scholar illustrates in a simple way the intricate neural processes that underlie depression and proposes some important tools to improve relationships, decrease worries and anxiety, and lighten the burden of negative thinking and depressed mood.
Korb argues that when you are depressed it is as if you are inside a downward spiral: nothing seems more interesting to us, we feel isolated and sad and we don’t know how to get out of it, because every decision we think we can make seems wrong. We end up in these harmful spirals because the events that happen to us and the decisions we make make changes to our brain activity. It is often thought that being depressed just means being sad all the time, but it means a lot more than that. Depression can lead to a feeling of numbness, as if we feel anesthetized and unable to feel emotions, helpless and hopeless. Everything seems to have lost the value it had before. And so, getting to sleep or sleeping without interruption during the night becomes difficult, the pains are felt more acutely and we lose concentration, we feel anxious, worried and alone.
The problem with this spiral is not only that it brings us down, but also that it makes this condition permanent . All the activities that could make us feel better (exercise, sleep well, do some fun activities with friends) appear too difficult and burdensome to carry on. So our mind is blocked, because depression continually pushes us down, as inexorable as the force of gravity .
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What happens in the brain
The scholar emphasizes that the circuits most involved in depression are two: the prefrontal cortex (eg, Samara et al, 2018), which is the seat of our higher functions, our thoughts and impulse control, and the limbic system (eg , Redlich et al., 2018), which instead is connected to affectivity and emotions. In depression, what does not work well is the communication and interaction between these two parties (eg, Mayberg, 2003).
The prefrontal cortex, which is supposed to help us regulate the emotionality and impulsivity triggered by the limbic system, doesn’t seem to be doing its job well. Thus, high levels of stress can cause the symptoms of depression because the hypothalamus, the heart of the limbic system, causes an increase in stress hormones, such as cortisol and adrenaline, when we are in stressful situations (eg, Miller et al., 2007), and sends fight-or-flight signals to the body (“fight or flight”).
The onset of depression also depends on the action of a very large number of neurotransmitters , which are generally released by our brain and perform different types of functions. When some of these neurotransmitters are not working as they should, some typical symptoms of depression may be observed. Among the main neurotransmitters we find:
- Serotonin – affects willpower, motivation and mood;
- Norepinephrine: increases concentration and the ability to cope with stress;
- Dopamine: increases pleasure and is necessary for the change of bad habits;
- Oxytocin: Promotes feelings of trust, love and connection, and reduces anxiety;
- GABA: raises the level of relaxation and reduces anxiety;
- Melatonin: improves sleep quality;
- Endorphins: promote pain relief and feelings of joy;
- Endocannabinoids: improve appetite and increase feelings of serenity and well-being.
All these neurotransmitters are necessary for the proper functioning of dozens of circuits within our brain and, as if that were not enough, they also interact with each other. Unfortunately, depression is not just due to low levels of norepinephrine, serotonin or dopamine, and therefore the problem is not solved by increasing the level of these neurotransmitters. However, doing so can be part of the solution.
Reverse the course: the spiral that pushes us upwards
Small and positive changes in our life can affect the activity of neurotransmitters and cause positive changes even at the neural level, affecting the electrical activity of the brain, its chemical composition, and even its ability to produce new neurons. These brain changes alter the regulation of neural circuits and lead to further positive life changes. For example, exercise changes the brain’s electrical activity during sleep, which in turn reduces anxiety, improves mood, and provides more energy for further exercise. Likewise, experiencing gratification activates the production of serotonin, which improves mood and helps avoid harmful behavior, providing additional reasons to feel gratified.
Now let’s see in more detail some of the steps to follow to start this process of change.
Exercise is probably one of the most direct and powerful ways to begin the ascent. Virtually all of the negative physical, mental and social effects of depression can be combated by exercising(eg, Joseffson et al., 2014). From a physical point of view, while depression makes us lethargic and tired, makes sleep-wake rhythms disorganized and reduces appetite and the urge to eat, leading us to eat little or ingest junk food, on the other hand exercise gives us energy and vitality, increases the quality of sleep, making it more restorative for the brain and improves appetite, increasing the pleasure of eating and the state of health. From a mental standpoint, depression makes it difficult to concentrate and worsens mood, while exercise makes us mentally sharp and more adept at planning and decision making, as well as improving mood, reducing anxiety, and stress and increase self-esteem. Finally, from a social point of view, While depression isolates us and makes us feel essentially alone, exercise encourages us to go out and make contact with the world. It is important to remember that the social drive can be a great incentive to undertake some type of training: asking a friend to do physical activity together, joining a group at the gym or being followed by a personal trainer are options that can help. .
Decision making is another important aspect that affects depression. In reality, we could say the opposite, namely that it is depression that prevents us from making decisions, because every decision is experienced as wrong. Making decisions means setting goals and having the intention to reach them, processes that make up the same neural circuit and that involve the prefrontal cortex in a positive way, reducing anxiety and worries. Furthermore, when we make decisions it changes the perception we have of the world, finding solutions to our problems and restoring calm in our limbic system.. Scegliere attivamente di perseguire uno scopo, piuttosto che affidarsi all’impulso del momento, alle abitudini o a un intervento esterno, è un comportamento particolarmente appagante. Infatti, quando un obiettivo a lungo termine viene raggiunto, ma anche quando vengono superati i passi che gradualmente portano a quel traguardo, c’è un cospicuo rilascio di dopamina. Un aspetto importante da tenere a mente è che focalizzarsi sui potenziali esiti negativi, piuttosto che su quelli positivi, rende il processo di decisione più arduo. Allora, potremmo individuare un obiettivo che vorremmo realmente realizzare, piuttosto che basare le nostre scelte sull’evitamento di qualcosa che non desideriamo. Per esempio, l’affermazione “Non vorrei trascorrere tutta la giornata in casa”, si potrebbe trasformare in “Vorrei uscire a fare una passeggiata”. Trasformare un nostro pensiero dandogli una valenza positiva, costruttiva e pratica è decisamente efficace nell’apportare cambiamenti benefici sul nostro comportamento.
One of the most common symptoms of depression is poor sleep quality . Non-restorative sleep worsens mood, lowers the pain threshold and interferes with learning and memory processes (eg, Havekes & Abel, 2017). It also makes us more impulsive and less focused. It also increases blood pressure, fuels stress, and negatively affects our immune system. It can also lead to an increase in body weight. In the brain, poor sleep quality has negative repercussions on the prefrontal cortex and hippocampus, and then alters the functions of the serotonin, dopamine and noradrenaline systems .
The factors that can help us reverse the course and make us go up the spiral of depression that had pushed us down are many and within our reach. Korb reminds us until the last page of his book that we have all the tools to be able to know and act on the neural and physical processes involved in the emergence and maintenance of depression. It is necessary to act, to set in motion to change the condition in which we feel stuck. If we don’t even find a good reason to get out of bed, we simply stop looking for reasons and get out of bed. Once the hippocampus recognizes that the context has changed, it stimulates the prefrontal cortex to find new answers. Even just reading this text and starting to think about it may have been helpful in activating important neural circuits. It takes very little to start climbing the spiral.
