BTRIPP (btripp) wrote,

Around and around and around we go ...

I'm not sure where I ran across a mention of Dr. Alex Korb's The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time, but as it is a very recent release (and I don't recall contacting the publisher for a review copy), I'm having to guess that it was mentioned in a recent LTER book, possibly The Upside of Stress, and I picked up a copy via Amazon.

Needless to say, I'm open to reading about pretty much anything that promises to “reverse the course of depression”, as my on-going financial difficulties (looking for work for over 6½ years will do horrible things to your life) have had me living on the edge of depression for a very long time, and this book sounded pretty on-target. After all, how “fluffy” could a book based on neuroscience be?

Well …

One would think a book involving both neuroscience and fighting off depression would be a home run for me, but somehow most of the stuff didn't ring true for me … or, at least, seem applicable as he presents it here. While the science stuff is fascinating, achieving most of the suggestions here would at least involve a coach, if not partial hospitalization. How am I supposed to arrange a “long hug” to release oxytocin and lower amygdala reactivity, if I'm lucky to score a random hug (from my daughters) 2-3 times a year? How can one “play Frisbee with friends in the park”, when it's been over a decade since one has had “friends” who weren't exclusively on the other side of a computer screen? Frankly, much of what Dr. Korb recommends as action points in here sound (to me) like he's saying “get your life together, and leverage that, then you can get out of being depressed” … with no suggestion how one can arrange to have people around (and note the economic element above – I'm not in a position to buy these) who want to hug or play with you. Anyway, that's me and the particular existential hell that I live in, I'm assuming that “your mileage may vary” and some of the stuff in here will be more actionable for others.

The book is divided in two parts with various chapters walking the reader through the underlying systems that either cause or are effected by depression … I hadn't wanted to fall back on a chapter listing in this, but it looks like I'm going to be less “summarizing the arc” of the book here, and more “cherry-picking choice bits”, so here's how the book is laid out …

      Part 1 – Stuck in a Downward Spiral
            1 – A Brain Map of Depression
            2 – Trapped with Anxiety and Worry
            3 – Always Noticing the Negative
            4 – Caught in Bad Habits
      Part 2 – Creating an Upward Spiral
            5 – Exercise Your Brain
            6 – Set Goals, Make Decisions
            7 – Give Your Brain a Rest
            8 – Develop Positive Habits
            9 – Take Advantage of Biofeedback
            10 – Activate a Gratitude Circuit
            11 – Rely on the Power of Others
            12 – Your brain in Therapy

One piece that I thought was pretty “defining” on how slippery the whole subject can be was: “Whereas most diseases are defined by their cause … the disorder of depression is currently defined by a collection of symptoms.” for which “There's no lab test, no MRI scan, it's just the symptoms.” and that “... there's nothing fundamentally wrong with the brain. It's simply that the particular tuning of the neural circuits creates the tendency towards a pattern of depression.”

Sounds like a pretty raw deal, eh? The brain's functioning fine, it's just mis-tuned without a nice adjustment knob to fiddle with. He does go into the chemistry of neurotransmitter systems, which includes a basic listing/defining of each:
  • 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

These keep coming up in various settings and combinations … one example of a “doable” suggestion is “go out in sunlight” which will help boost serotonin production, and the release of melatonin.

The author also goes through the basic parts of the brain, the Prefrontal Cortex, with the various regions: Dorsomedial, Ventromedial, Dorsolateral, Ventrolateral, and Orbitofrontal … and the Limbic System, with the assorted parts: Anterior Cingulate, Hypotalamus, Hippocampus, and Amygdala … along with a couple of other bits, the Striatum, with the Dorsal Striatum and the Nuclear Accumbens, and the Insula. He goes through the known functions of these in relation to depression (but, obviously, it's too much to get into detail on here) an example is:
Dopamine is released in the nucleus accumbens whenever you do anything fun and exciting – or at least it's supposed to. In depression, reduced dopamine activity in the nuclear accumbens explains why nothing seems enjoyable.
In advocating for attempting to move into an “upward spiral”, he notes:
... depression comes from problems with frontal-limbic communication, and that it happens because of the specific tuning of your neural circuits … it turns out that just a little change can be enough to push you away from depression … that's because in complex systems like the brain, even a little shift can change the resonance of the whole system.
And, while that last statement sounds a bit woo-woo Korb got his neuroscience undergraduate at Brown and his PhD at UCLA, and is a post-doctoral researcher in the UCLA department of psychiatry, so ought to have a pretty good fix on this (although part of me thinks that the phrase “resonance of the whole system” evokes images of Tibetan Singing Bowl “therapies” more than anything).

Throughout the book he has grey boxes that feature “suggestions” for things to do. Frankly, a lot of these came across (to me) as “nagging” (OK, especially all those having to do with exercise), but some are pretty perceptive, direct, and doable, here's one (fairly lengthy – sorry about that) that I found particularly useful:
Make a good decision, not the best decision. When trying to make a decision, we tend to focus on the relative drawbacks of each option, which often makes every decision seem less appealing. Nor do we usually have enough information to feel confident in the decision – the world's just too complex. But remember, it's better to do something only partly right than do nothing at all. Trying for the best, instead of good enough, brings too much emotional ventromedial prefrontal activity into the decision-making process. In contrast, recognizing that good enough is good enough activates more dorsolateral prefrontal areas, which helps you feel more in control.
As is evident from that “to-do item”, there's a lot of stuff in here that is brain-area specific, targeted to either enhancing or inhibiting levels of the neurotransmitters listed above. He elaborates on the suggestion for making decisions by noting:
Your brain, like your muscles, operates on a use-it-or-lose-it basis. Using a particular brain region will strengthen it, while disuse will weaken it. One problem with depression is that it makes you use a lot of the brain circuits that keep you stuck and less of the brain circuits that help you get better.
An interesting chapter (that I also found somewhat “naggy”) is the “Give Your Brain a Rest” one, which deals with what he refers to as “sleep hygiene”. One factoid I found fascinating was the “sleep architecture” piece where Korb walks the reader through a phase-by-phase look at what happens in a “sleep cycle” – which typically takes 90 minutes. I guess I glommed onto this because for years I was pretty much a 3-hour-of-sleep guy, which means that I was making do with 2 sleep cycles (instead of the 5-6 an 8-hour rest would entail) … which has grown to 4 as I've gotten older. One of the more “naggy” things here is when he gets into syncing one's sleep schedule with one's Circadian Rhythms … and some of his suggestions there are just extreme if one lives with a lot of electronics (or, in my case, an environment with a lot of ambient light).

In the “Developing Positive Habits” chapter, he starts off highlighting the underlying problem:
Habits are created by repetition. Interestingly, some habits require less repetition than others, because some actions inherently release more dopamine. Unfortunately, bad habits are the ones that often release lots of dopamine, so you don't need to do them very often to get hooked. Smoking releases a lot of dopamine in the nucleus accumbens, so you don't have to smoke very many cigarettes to start a habit. In contrast, flossing doesn't release very much dopamine, so you have to floss every day for a long time to make it a habit. … The good news is that the dorsal striatum responds to repetition. It doesn't matter if you want to do something – every single time you do it, it gets further wired into the dorsal striatum … if you can power through, things will feel easier as the burden of the action shifts from the consciously effortful prefrontal cortex to the unconsciously effortless dorsal striatum.
Bizarrely, he also says that (to me, a bit newagey, touchy-feely) self affirmations help break bad habits … he reports on a study that had participants complete a questionnaire which highlighted their positive qualities before being exposed to negative information about a bad habit (in this case smoking) … “smokers in the self-affirmation group developed a greater intention to quit smoking … {and} the effect of self-affirmation was strongest on the heaviest smokers”. Who knew that Stewart Smalley was that clued in?

The “biofeedback” chapter isn't about getting your head wired up to a machine (or Yoga, which the author starts off discussing), but is more generically about how “the brain changes its activity based on what the body is doing”. One amusing sidebar discusses how a stress sensation in the gut is very likely to be interpreted by the brain as hunger – hence the familiar phenomenon of “nervous eating” – he suggests that “These types of signals are like your car's check-engine light – alerting you that something is happening, but not being very helpful in telling you what.”! He has a number of suggestions to use to make those physical messages work on your brain, from splashing cold water on your face to break a cycle of “feeling overwhelmed, stressed, or anxious”, to using music to “help regulate your emotions”, to even forcing yourself to smile. He further suggests to laugh even if nothing is funny … noting: “The brain doesn't distinguish much between genuine laughter and fake laughter.”, which he further elaborates with:
Facial feedback works because the brain senses the flexing of certain facial muscles (like the zygomatic major muscle at the corners of your mouth), to which the brain thinks, I must be happy about something. Similarly, if that muscle isn't flexed, you brain thinks, Oh, … I must not be happy.
He also suggests (along with your mother and/or drill sergeant) standing up straight. And, to avoid things (like squinting) that would mimic stress patterns in the facial muscles (to the extent of recommending wearing sunglasses to avoid one's corrugator supercilii contracting and messaging the brain that one is upset or worried). There are more tips about breathing and various muscle cues to either avoid or to mimic. Stupid brain … what a sucker!

I was probably most “reactive” against the “Gratitude” chapter, because, hey, those “Laws of Attraction” folks are real irritating. Fortunately, it's only 10 pages and not insufferably newagey. He hits about a dozen key points here, and while he footnotes studies for these he doesn't go into much detail other than glossing the results with statements like “activates the brain stem region that produces dopamine”, or “increases serotonin production in the anterior cingulate cortex”. I was similarly fighting against the “other people” chapter, given my general isolation over the past few decades (the author does not at the start of the chapter: “Depression is an isolating disease. It makes you feel separate and alone, even around other people ...” and later follows with “Humans are a social species … that means that when we feel disconnected, the consequences can be devastating.”. None of this is helped by the “downward spiral” effects – noting that depressed people “have even greater anterior cingulate activation, suggesting their brains are more sensitive to social rejection … generating a stronger stress response”), which makes much of the info here, well … depressing. However, there was one fascinating bit here that came out of a study of 8-12-year-old girls who were subjected to a stressful event (having to “solve difficult SAT questions in front of an audience”), there were four groups, differentiated by what they did after the stressful experience – one set got to visit with their mothers, one set got to talk to their mothers on the phone, one set got to “text” with their mothers, and one set got no follow-up contact at all. The first two groups had “improved” cortisol-oxytocin levels, while the no-contact group had a bad mix (high cortisol, low oxytocin) of the neurotransmitters. What was especially notable in this study was that the girls who were just able to text with their mothers had very similar levels to the no-contact group … indicating that something (emotion?) wasn't coming across via the text messages. I found this especially illuminating as I always prefer email to the phone – primarily to avoid any emotional “Jedi mind tricks” that people tend to use in spoken communications! One of the other things he recommends is rooting for sports teams – with others – so I wouldn't be surprised to find him doing promos for sports bars.

The last chapter is about getting therapy, from standard talk therapy to massively invasive things involving brain surgery or ECT, with a discussion of assorted drugs being used (or developed) for various issues. All nice stuff if you can afford it, I suppose.

The key element that he ends with is urging the reader to at least try to do something to break the brain out of its depressive cycles. This might be (for the deeply depressed) as basic as getting out of bed even if one can't come up with a reason to do so … sort of like Nike's “just do it” – it will help break the cycle (somewhat like splashing cold water creates a neural shock and can interrupt a state of mind). He closes by pointing out the act of finishing the book is likely to create a puff of dopamine … which may be why I'm so fond of reading books.

Anyway, The Upward Spiral has only been out since March, so you have a reasonable chance of finding it in the still extant brick-and-mortar book vendors with “self help” sections (and which of those don't?). The on-line big boys have it, of course, presently at about 25% off of cover price. Interestingly, this hasn't gotten deeply into the new/used channels, so you'd not be saving much (with shipping) going there at this point. As is evident in all the preceding, I'm pretty torn on this, I found the science parts quite educational, but had a “dark/sarcastic/reactive” response to most of the touchy-feely stuff, although I'm likely to add several bits and pieces to my on-going activity when nothing else is working. If you're fighting depression (or are close to somebody who is), and aren't as cantankerous as I am, you'll likely get a lot of this and be quite enthusiastic about it. I guess I'm going to have to wait for “Fighting Depression for Cranky Cynics” to come out.

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Tags: book review

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