The Neuroscience of Depression: An Interview with Dr. Alex Korb

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The following is an edited transcript of the podcast recorded interview with Dr. Alex Korb.  This transcript has not been reviewed and is not a word-by-word rendering of the entire interview.

Hi, I’m Dan Lukasik from lawyerswithdepression.com. Today’s guest is Dr. Alex Korb.  Dr. Korb is a neuroscientist, writer, and coach.  He’s studied the brain for over fifteen years, attending Brown University as an undergraduate and earning his Ph.D. in neuroscience from UCLA. He has over a dozen peer-reviewed journal articles on depression and is also the author of the book, The Upward Spiral: Using Neuroscience to Reverse the Course of Depression One Small Change at a Time. Interesting, he’s also coached the UCLA Women’s Ultimate Freesbie team for twelve seasons and is a three-time winner for Ultimate Coach of the Year.  His expertise extends into leadership and motivation, stress and anxiety, mindfulness, physical fitness, and even standup comedy. Welcome to the show.

Dr. Korb:

Thank you, great to be here.

Dan:

Let’s begin for our audience.  You’re a neuroscientist. What is neuroscience?

Dr. Korb:

Neuroscience is simply the study of the brain and nervous system. It’s a branch of biology, but it also incorporates aspects of psychology, psychiatry, and neurobiology.  It’s anything that’s going on in the brain and nervous system all under the purview of neuroscience.

Dan:

You’ve studied depression as a neuroscientist?

Dr. Korb:

Yes, that’s what I wrote my dissertation on. The aspect of neuroscience that I’m most interested in is what underlies the neural basis for our moods and emotions, behaviors, and psychiatric illnesses. Some peer-reviewed articles look at schizophrenia as well as other psychiatric disorders like depression which have a lot of basis in neuroscience and we just don’t fully understand what is happening in the brain.

Dan:

Based on your research, can you tell us what’s going on in the brain when someone is suffering from depression?

Dr. Korb:

The best way to describe it is a dysfunction in frontal-limbic communication. To simplify it, there’s a problem with the way the thinking, feeling, and action circuits in the brain are communicating with each other.  Those all have different regions of the brain that are more dedicated to each aspect of thoughts, feelings, and actions. But, normally, there’s a dynamic of how these regions are supposed to communicate with each other, and there’s something with depression that’s a little bit off.

Dan:

Can the same be said for anxiety as far as what’s going on in the brain?

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Dr. Korb:

Yes, anxiety and depression have a lot of overlap regarding the neuroscience and neurobiology behind them.  A lot of the same brain regions are involved. For example, the amygdala, which is often called the fear center of the brain, but is involved in a lot of emotional expressions, that’s one of the core emotion regions in the brain, and it plays a role in both depression and anxiety.  And there’s just a lot of overlap in brain regions, and neurochemistry that underlies these disorders and it’s one of the reasons why anxiety is one of the most common features of depression and they often co-occur together.

Dan:

When I’ve tried to explain what I was suffering from, and my symptoms and I called it “depression,” most people didn’t have any frame of reference for that. They usually thought of it as “sadness.” With respect to sadness and depression, are there different areas of the brain that pertain to sadness that are different from clinical depression?

Dr. Korb:

There’s a lot of overlap between sadness and depression, but a lot of the misunderstanding that people have is that we use the term depression and sadness, “I’m feeling depressed” or, “I’m feeling sad,” we use those colloquially, very interchangeably.

But medically, or neuroscientifically, they’re very different.

Depression and the diagnosis of depression are a lot more than simple sadness.  In fact, a lot of people who suffer from depression don’t feel sad per se. They can often feel an emptiness where emotion should be.  They have a lot of other symptoms such as hopelessness and feelings of helplessness, guilt and shame, isolation, and anxiety can be a part of it.

They can have fatigue, problems falling asleep or staying asleep or even sleeping too much and, generally, the things that they used to find enjoyable they no longer find enjoyable. Everything just feels very difficult.

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It’s hard to explain to someone why it’s difficult because it seems like it shouldn’t be. It’s a much deeper feeling of being stuck than most people experience.  I think the average person if you can think of how you felt after the week of your greatest heartbreak, that sort of touches the edge of what it means to be depressed. It’s not the depth of how badly you feel, but that you can’t escape it. For example, I like to think of depression as a traffic jam.  When you enter a traffic jam, sometimes there’s an accident. The cars are stopped, and you sit there and wait.  And you don’t know how long the traffic jam is going to be. But for most people, it was just a little stoppage on their way. But for people with depression, it’s something that their brain just can’t quite escape. They can try and try, but their brain is stuck in the pattern of activity that just drags along, and the traffic jam just continues.

Dan:

That’s a great explanation of the experience of depression. Both what’s going on in the brain and psychologically. I think people want to know what are some of the causes of depression? Many people once they’ve often been diagnosed try to figure out for themselves, and people who care about them try to figure out?

Dr. Korb:

Depression can have a huge number of different causes. This is where the traffic jam analogy does a lot to help us understand depression. If you see a traffic jam, you can say, “Oh, what caused it?” Well, a traffic jam can come from any number of causes. There’s construction on the freeway, or there was an accident, there was heavy rain or fog, or it could just be that everyone decided to leave work at the same time, and there’s no specific “cause,” it’s just that the interaction – the dynamic interaction – of all those cars just reaches a tipping point.

With depression, it’s the same way. Often, it can be precipitated by a big life event such as a divorce, or breakup, or death in the family. Or smaller life events such as a perceived emotional embarrassment or you didn’t get that promotion.  But, often it’s not “caused” by anything.  It’s just the dynamic interaction of your brain circuits with each other, combined with the sum of your current life circumstances, which causes the brain to get stuck in a certain pattern of activity and reactivity.

That’s much more likely to happen for some people than others because some people’s brains are just more at risk for falling into that pattern. This can be based on the genes you got from your parents, and your early childhood experiences and the coping patterns you’ve been doing your whole life shaped the neurocircuitry and neurochemistry of your particular brain.  So, it’s not always a specifically, identifiable cause.  I think that’s one of the reasons why people, sometimes, don’t quite believe that it’s real or don’t think they should be suffering it. But, it’s very similar to that traffic analogy where it just “sort of happened” for seemingly no reason. It’s just caused by the fact that is vague, nonlinear, dynamic system.

Dan:

Why did you write the book, The Upward Spiral? There are plenty of scientists out there who study depression, but not many of them write a book for the general public on the topic.  What is it that led you to write this kind of book?

Dr. Korb:

I just realized that there was so much useful neuroscience out there that wasn’t being effectively delivered to the people who needed it most. One of the things that made me realize that is from when I was coaching Ultimate Freesbie. After a few months, one of the girls on the team revealed to me that she had been suffering from major depression and that she’d been suffering for years, and, tragically, many months later she ended up committing suicide. It was a devastating event in my life. This was back when I was still studying neuroscience, but before I had decided to go to grad school and study depression. That event led me to want to understand exactly what was going on in her brain that could lead her to do something like that. How could the brain get stuck in a disease like this?

That lead me to going to grad school and doing my dissertation on depression to try and understand and share some of these things with other people. As I was doing my dissertation, I realized that, yes, it’s good to advance the science, but there was already so much good science out there that was so beneficial. I didn’t think that anyone was doing a good enough job communicating clearly exactly about what was happening in the brain in depression and about all the little life changes that you can make that have measurable effects on brain activity and brain chemistry.

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Dan:

The second part of your book is devoted to eight specific things you can do to alleviate depression. Quickly, they exercise your brain, set goals and make decisions, give your brain a rest, develop positive habits, biofeedback, develop the ‘gratitude circuit,’ the power of others, and your brain in therapy. We don’t have enough time to focus on all eight, so why don’t we focus in on one or two. What I thought was fascinating is that you give the backdrop for what is going on in the brain when you do these things.  A few things that popped into my mind were gratitude and your brain in therapy. What about gratitude? How can it help depression?

Dr. Korb:

Gratitude can have a lot of powerful effects on the brain. And one of the reasons going back to why I wrote this book, is that there are tons of books out there that will tell you different life changes that you can make that will help with depression, but I’ve found that a lot of them are unsatisfying because they don’t explain, why. Therefore, it’s not as convincing, and it’s very easy for people to dismiss.

So when I talk about gratitude and how practicing gratitude can be so powerful in overcoming depression, a lot of people can resist that idea because it sounds so hokey.  But if I can point to specific neuroscience studies that show that it has measurable effects in changing brain activity and brain chemistry, then you’re much more likely to do it and it gives you a much better understanding of what’s going on. Gratitude has been shown to, if people who keep a gratitude journal, improve the quality of their sleep, and sleep symptoms of depression are one of the causes of depression. The reason why I called my book, The Upward Spiral because depression can sort of be seen as a “downward spiral” where one symptom or one event can lead to seemingly to a whole cascade of events that keep you stuck. So, gratitude can help break the downward spiral that’s coming from sleep problems that are leading to difficulty in concentration, and that’s one place to break the loop.

Dan:

After reading the chapter on gratitude, I picked up a spiral notebook and started a gratitude list. It was more of a lifetime gratitude list. It’s amazing. I came up with eighty things. I was surprised. So often my experience with depression is that we ruminate about negative things. We just don’t take the time, or don’t have the skill to savor and reflect on the good things in our lives.  It seems what you’re saying is that this practice has effects in the brain.

Dr. Korb:

Yes, when you’re in a depressed state it’s much harder to see the positive aspects of your life. But that’s why it’s all the more important to build a habit of looking for those positive things because often the most important feature of gratitude is not finding something to be grateful for. It’s remembering to look in the first place because that activates the prefrontal cortex which is the more thinking part of the brain which helps it to regulate the emotional regions of the brain that are going haywire in depression.

And gratitude increases activity in the key region of the brain called the cingulate cortex that sits at the intersection between the emotional limbic system and the rational prefrontal cortex and helps modulate communication between those. Remembering things in your past that you are happy or grateful for actually increases the production of the neurotransmitter serotonin in that same brain region and serotonin is one of the most common targets for antidepressant medications.  Practicing gratitude is having effects in key brain regions that we know contribute to depression and in the neurotransmitter systems that are contributing to depression.

Dan:

I also found it interesting your chapter on our brains and therapy. What’s interesting is that many people who treat with a therapist find comfort and solace in going to therapy when they are struggling with depression. They walk out, and they often do feel better at times don’t’ always understand why they feel better.  Or, we know, there’s a recent study from National Institute of Mental Health, which concluded that as many as eighty percent of people in this country get no treatment for depression whether it be antidepressants or therapy.  So, why is it important, if at all, for people to go to therapy who struggle with depression?

Dr. Korb:

The chapter that I wrote on therapy encompasses not just psychotherapy – going to talk to someone – but it also includes medical therapy such as antidepressant medication or other forms of therapy like neuromodulation techniques. These have been demonstrated through rigorous, double-blind studies that show they have powerful effects on treating depression.  Going to see a professional if you think you are depressed is a hugely important step because they can put at your disposal all the advances of western medicine.

What’s interesting – and it’s the last chapter in the book – and it’s funny how many comments I get because they say, “You left antidepressants to the end because it’s not that important and there are other life changes people can do.” Another psychiatrist will say to me, “Why are you so dismissive of antidepressant medication? They are hugely important in the treatment of depression.”  It’s neither of those. I agree that antidepressants and psychotherapy are extremely important in the treatment of depression, and if you think you are suffering from depression, you should go to see a health professional whether it’s just your doctor or you go to see a psychotherapist.

I just don’t think antidepressants are the entire answer.

For some people, I would say about one-third of people suffering from depression; antidepressants are the answer. You can get over your depression completely simply be taking a pill. You don’t know if you might be one of those people. So, you might as well see a doctor and find out.

For the other half or two-thirds of people, antidepressant medication can still be a huge part of the answer, even if it’s not the entire answer. Taking antidepressants can also help you make these other small life changes such as increasing exercise, or changing your sleep habits, or practicing gratitude.  As you make the other small life changes, then things can start to spiral upward.

Dan:

It’s been an informative and very interesting interview with you Dr. Korb.  I want to thank you for being on the show and I highly recommend listeners to pick up and read his book, The Upward Spiral: Using Neuroscience to Reverse the Course of Depression One Small Change at a Time.  Join us next week for another interesting interview at Lawyerswithdepression.com.

I encourage everyone to check out Dr. Korb’s website at alexkorbphd.com.

 

What’s Up? Gratitude and Depression

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When first squashed by clinical depression years ago, some told me to think of all the things I had to be thankful for – as if this would cure my “blues.”

But I didn’t have the blues. I didn’t just feel “sad.”  I had an illness.  I had entered a long, dark tunnel.  I didn’t see a glimmer of light at the end of it.  I wandered in it for years before things got better.  At some point, I saw an end, of sorts, in sight.  I exited that tunnel and felt the warming sun of life reinvigorating my body. I knew I was going to be okay.

It was only after having exiting the tunnel that I was capable of even thinking about gratitude.  But now it’s an important part of my “Depression Toolkit”: things I do to keep what sufferer Winston Churchill called “the black dog” at bay.

Listen to the podcast of my interview with Rabbi Mark Gellman

Lawyer Fight-Or-Flight And Its Connection To Depression

Lawyers are control freaks.  Okay, maybe they have to be. There’s is so much going on that they actually do have to control things to be good at their jobs.  But it creates a grind of perpetual stress; every day, all-out stress seizures to control of events and people that are all too often uncontrollable leaving them depleted by the constant firing of their bodies’ fight-or-flight reaction.

We all learned in high school biology about the fight-or-flight response; a binary system of survival that kept our hairy, grunting ancestors alive in prehistoric times when meandering about the Sarengeti plains.  This lighting quick response evolved to make us scamper from threats we could outrun and brawl with ones we couldn’t.

Today’s’ lawyers are embedded with the same nervous system their Neanderthal ancestors had 30,000 years ago.  When they’re threatened on the job, their heart rate fires, breathing becomes shallower to divert oxygen to muscles and stress chemicals are dumped into their bodies.  This all happens automatically, before they’ve even had a chance to think about it.  And it happens even when they’re not being chased by a ravenous cougar or fighting a loin clothed adversary.

When our body’s stress response is triggered, it does not know the difference between true physical threats to our physical survival and psychological threats to our sense of self.  Think about how much our hearts pounds in a contentious deposition, for example.  Our bodies, unable to actually physically run or fist fight in the office, surge with stress hormones as if we were in a bloody life-or-death battle for control of that deposition with a dastardly adversary.

For lawyers prone to anxiety and depression, the daily surges of the stress hormone cortisol are particularly troublesome because of its impact on the hippocampus and the amygdala in the brain.

The hippocampus is that part of the brain that remembers details and helps you put incoming information into context.  It is without emotions, registering and storing details of events, functioning like a Joe Friday from Dragnet:  “Just the facts, mam.”

The amygdala is the brain’s early warning system and is a major cause in genetically depressed moods and negative thinking. It acts as an importance meter, registering tone and intensity and tells your brain instantly if it should prepare for trouble.  It scans the environment looking for danger.

Too much cortisol, over too long a period of a time, can cause depression and result in actual changes to the brain.

Physician John Ratey writes in his best-selling book Spark:

“Chronic depression causes structural changes to the brain.  Research has showed that depressed patients had measurable changes in the amygdala and the hippocampus, crucial players in the stress response.  We knew the amygdala was central to our emotional life, but they also found that the memory center was also involved in stress and depression.  High levels of the stress hormone cortisol kill neurons in the hippocampus.  If you put a neuron in a petri dish and flood it with cortisol, its vital connections to other cells retract.  Fewer synapses develop and the dendrites wither.  This causes a communication breakdown, which, in the hippocampus of a depressed brain, could partly explain why it gets locked into thinking negative thoughts – it’s recycling a negative memory, perhaps because it can’t branch out to form alternative connections.  At the same time, MRI shows that new nerve cells are born every day in the hippocampus and possibly the prefrontal cortex – two areas shriveled in depression.  Now we see depression as a physical alteration of the brain’s emotional circuitry.

Norepinephrine, dopamine, and serotonin are essential messengers that ferry information across the synapse, but without enough good connections in place, these neurotransmitters can only do so much.  As far as the brain is concerned, its job is to transfer information and constantly rewire itself to help us adapt and survive.  In depression, it seems that in certain areas, the brain’s ability to adapt grinds to a halt.  The shutdown in depression is a shutdown of learning at the cellular level.  Not only is the brain locked into a negative loop of self-hate, but it all loses the flexibility to work its way out of the hole.”

In the privacy of their offices or in anonymous phone calls, I’ve heard many lawyers with depression tell me they hate themselves.  They hate themselves because they’re stuck in depression and spinning their wheels.  Rather than see this predicament as something that can be explained as an illness going on in their brain, they mercilessly punish themselves and feel they’re weak and lazy.

In his book Undoing Perpetual Stress: The Missing Connection between Depression, Anxiety, and 21st Century Illness, Dr Richard O’Connor writes:

“For an overwhelming number of people today, the result of the vicious circle of perpetual stress is a state of permanent malfunction: dissatisfied, irritable, overwhelmed and hopeless, out of control, frightened, physically run down and in pain.  For want of a better term, this is what I call the “Perpetual Stress Response.” Overwhelmed by too many stress hormones in our system, our cells close down receptor sites to try to compensate; but that just makes the endocrine system pump out even more stress hormones.  Continually bathed in neurotransmitters telling us there is constant danger.  And our brains become rewired by stress, our neural circuitry restricted to firing along preconditioned pathways, so that we are literally unable to think of new solutions, unable to come up with creative responses.”

Anxiety and depression are terrible coping mechanisms.  If so, why do lawyers in such large numbers suffer from these maladies?  Because they don’t know what else to do and don’t realize the damage they’re doing to their bodies and minds by living with the fight-or-flight furnace turned on high all day long.

So what is a depressed lawyer to make of all of this?  Like recovery from any illness, awareness goes along way.  For many with depression, it will take a long time and periods of suffering, to see, to truly see, that anxiety and depression don’t work as coping mechanisms and that they have to learn better ways in which to run their lives to help their brains.

In my next blog, I’ll explore what we can do about this situation.

Finding Our Way in the Law

It’s in the darkness of men’s eyes that  they get lost – Black Elk

Graduating from law school is both exciting and frightening at the same time.  There’s a real itch to put our knowledge into action, to be a bona fide “attorney at law” and to start making some dough instead of spending it on tuition and books. On the other hand, we really don’t know a lot about the application of legal theory to legal combat, may have a heap of debt and pray that our first stab at competency doesn’t land us face first on the courthouse steps. 

Beyond all of these pragmatic concerns is the meatier matter of living a life in the law that matters; a life in accord with our inner core of what we truly value in life.  As author Studs Turkel once wrote:

“Work is about a daily search for meaning as well as daily bread, for recognition as well as cash, for astonishment rather than torpor, in short for a sort of life, rather than a Monday-to-Friday sort of dying.”

Lawyers, young and old alike, find it difficult to live out their values in the workplace, to search for “meaning as well as daily bread.”  There are challenges and compromises, some more difficult than others.  For example, we may really value spending time with our family.  But as the demands of our career mount, we become untethered from this life-giving sustenance as we spend more and more time toiling at the office.

Andrew Benjamin, Ph.D., J.D., a lead researcher in studies about the mental health of law students and lawyers, concludes that much of the dissatisfaction in the profession comes from a widening gap between the values we truly care about and the things we end up pursuing in in our jobs as lawyers.  This takes place over time and its effects are cumulative.  Many end up leaving the profession.  Or, if they stay, are mired in unhappiness, discontent and can’t see a way out.

Dr. Benjamin found that approximately 20% of lawyers – about twice the national average – aren’t just unhappy; they’re suffering from clinical anxiety or depression. We aren’t talking about everyday stress, sadness, blues or categorical grumpiness.  We’re talking rubber to the road clinical anxiety and depression; devastating diseases that cause breakdowns in every area of one’s life.  Put in perspective, Benjamin’s studies suggest that a whopping 200,000 of this nation’s 1 million lawyers are struggling – some very badly.

Certainly a gap between our values and the way we live as lawyers doesn’t cause depression.  But it’s one of many factors that include a history of depression in one’s family and emotional abuse and/or neglect during one’s formative years that make a person prone to depression. 

Lawyers also seem to have a particularly fearsome type of stress overload; a jacked central nervous system fueled by the adversarial nature of the trade.  Modern science now knows that there is a powerful connection between chronic and remitting stress and the development of clinical depression.  As I wrote in “How Stress and Anxiety Become Depression,” chronic stress and anxiety causes the release of too many fight-or-flight hormones such as cortisol which damages areas of the brain that have been implicated in depression: the hippocampus (involved in learning and memory) and the amygdala (involved in how we perceive fear).

The point of all this sobering news isn’t to rain on anyone’s parade.  Law can and should be a noble calling and a satisfying way to make a living.  Rather, these warnings are meant to impart some thorny wisdom: living out your values and dreams are just as important as – to quote my brother Wally’s favorite expression, “carving out a living”.  Or, as Studs Terkel earlier surmised:  “. . . to have a sort of life, rather than a Monday-to-Friday sort of dying.”

It’s scary when you sense that you’ve wasted a lot of time doing a type of law – or law at all – that fails to connect with your deeper values.  Part of the fear is driven by the growing sense as we age that we don’t have forever – we are finite beings.  When we don’t know the way, can’t find path to move our outer life closer to our inner life, we can experience a sort of existential terror.  We may be sitting in a classroom, at court or just wandering downtown during our lunch break and a visceral sense that we yearn for something else will hit us.  How many of us quickly dismiss such thoughts as minor meanderings that aren’t worth our time.  But, these thoughts may keep coming.  Listen to them.  If we don’t, we may risk greater peril.

Gregg Levoy, author of Callings: Finding and Following an Authentic Life, talks about the dangers of not following the murmurs coming from within us all:

“Of course, most people won’t follow a calling until the fear of doing so is finally exceeded by the pain of not doing so – pain that we appear to have an appalling high threshold for. Eventually the prospect of emotional and financial turmoil, the disapproval of others and the various conniptions of change, can begin to seem preferable to the psychological death you are experiencing by staying put.  Those who refuse their passions and purposes in life, though, who are afraid of becoming what they perhaps already are – unhappy – won’t of course experience the unrest (or the joy) that usually accompanies the embrace of a calling.  Having attempted nothing, they haven’t failed, and they console themselves that if none of their dreams come true then at least neither will their nightmares.”

So remember your values and where they are trying to lead you.  That’s realistic.  Our values are not set in granite; they can and will change over time.  Yet the only tuning fork you will ultimately have is trying to build a solid bridge between who you really are and what you are in the real world.  We can and will hit choppy waters as we sail our ships in our careers.  There will be many temptations – money, power.  This story has been played out for millennia.  As you go through your career, watch the currents and stir your ship bravely, with integrity and passion.

As Apple founder Steve Jobs wrote:

“Your time is limited, so don’t waste it living someone else’s life.  Don’t be trapped by dogma – which is living with the results of other people’s thinking.  Don’t let the noise of other’s grievances drown out your own inner voice; and most important, have the courage to follow your heart and intuition.  They somehow already know what you truly want to become.  Everything else is secondary.”

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