Dr. Alex Korb is a neuroscientist, writer, and coach. He has studied the brain for more than twenty years, attended Brown University as an undergrad, and earned his Ph.D. in neuroscience from UCLA. He’s published over a dozen peer-reviewed journal articles on depression and is also the author of the books “The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time,” published in 2015, and the updated, revised edition, recently released in November 2025 by New Harbinger Publications. More information about Dr. Korb is available on this website.

Based on ALM and industry surveys, roughly 28% to 35% of lawyers experience depression, making them nearly three times as likely to suffer from it as the general U.S. adult population. Stigma is still rampant in the legal profession, and many don’t get help because of it. Or, just as commonly, they feel it is a moral weakness.  In this interview, I talk with Dr. Korb to understand the brain science behind depression and how, by understanding it, the legal profession might come to terms with depression as an illness with serious effects on the brain.

Dan: What exactly is neuroscience?

Dr. Korb: Neuroscience is simply the study of the brain and nervous system. It’s a branch of biology, but it also includes aspects of psychology, psychiatry, and neurobiology. It encompasses anything happening in the brain and nervous system, all within the scope of neuroscience.

Dan: Have you studied major depression as a neuroscientist?

Dr. Korb: Yes, that’s what I wrote my dissertation on. The part of neuroscience that interests me most is the neural basis of our moods, emotions, behaviors, and psychiatric illnesses. Some peer-reviewed articles examine schizophrenia and other psychiatric disorders like depression, which have a strong neuroscience foundation, but we still don’t fully understand what’s happening in the brain.

Dan: Based on your research, can you tell us what happens in the brain when someone is suffering from depression?

Dr. Korb: The best way to describe it is as a dysfunction in frontal-limbic communication. To put it simply, there’s an issue with how the thinking, feeling, and action circuits in the brain communicate with one another. Each of these processes involves different regions of the brain that are specialized for thought, feeling, and action. Normally, there’s a dynamic way these regions are supposed to communicate, but in depression, something about that process is a little off.

Dan: Can the same thing be said about clinical anxiety related to what’s happening in the brain?

Dr. Korb: Yes, anxiety and depression share many similarities in their neuroscience and neurobiology. Many of the same brain regions are involved. For example, the amygdala, often called the brain’s fear center but also involved in many emotional expressions, is one of the key regions associated with emotion. It plays a role in both depression and anxiety. There’s a lot of overlap in the brain regions and neurochemistry underlying these disorders, which is one reason why anxiety is a common feature of depression and why they often occur together.

Dan: When I tried to explain what I was going through and called it “depression,” most people didn’t have any frame of reference for it. They usually thought of it as “sadness.” Regarding sadness and depression, are there different areas of the brain involved in sadness compared to clinical depression?

Dr. Korb: There’s a significant overlap between sadness and depression, but much of the misunderstanding people have is that we use the terms depression and sadness—saying, “I’m feeling depressed” or “I’m feeling sad”—very interchangeably in everyday speech.

Medically and neuroscientifically, they are very different. Depression and the diagnosis of depression involve much more than simple sadness. In fact, many people who suffer from depression don’t actually feel sad. Instead, they often experience a blank emptiness where emotion should be. They also have numerous other symptoms, such as hopelessness, feelings of helplessness, guilt, shame, isolation, and anxiety.

They may experience fatigue, trouble falling asleep or staying asleep, or even sleeping too much. Generally, things they used to enjoy no longer bring them joy. Everything just feels very challenging.

It’s hard to explain to someone why it feels so difficult because it doesn’t seem like it should be. It’s a much deeper sense of being stuck than most people experience. I think the average person, if you think about how you felt after the week of your greatest heartbreak, that kind of compares to what it means to be depressed. It’s not about 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 wait. And you don’t know how long it will last. For most people, it’s just a minor delay. But for those with depression, it’s something their brain just can’t quite break free from. They try and try, but their brain gets stuck in this pattern of activity that just drags on, and the traffic jam continues.

Dan: That’s a great explanation of the experience of depression, covering both what’s happening in the brain and psychologically. I think people want to know some of the causes of depression. Many, once diagnosed, try to figure it out themselves, along with those who care about them.

Dr. Korb: Depression can have many different causes. The traffic jam analogy helps us understand depression more clearly. If you see a traffic jam, you might ask, “What caused it?” A traffic jam can happen for various reasons: construction on the freeway, an accident, heavy rain or fog, or simply everyone leaving work at the same time. Sometimes, there isn’t a specific “cause”—it’s just that the interaction—the dynamic interaction—of all those cars reaches a tipping point.

With depression, it’s similar. Often, it can be triggered by a major life event like a divorce, breakup, or a family death. Or by smaller events, such as feeling emotionally embarrassed or not getting that promotion. But, often, it’s not caused by any specific event. It’s simply the result of the complex way your brain circuits interact, combined with your current life circumstances, which causes the brain to become stuck in a particular pattern of activity and reactivity.

That’s more likely to happen to some people than others because some brains are more prone to falling into that pattern. This can be influenced by the genes inherited from your parents, as well as early childhood experiences and the coping patterns you’ve used your whole life, which shape the brain’s neurocircuitry and neurochemistry. So, there isn’t always a clear, identifiable cause. I think that’s part of why some people don’t quite believe it’s real or don’t think they should be suffering from it. But it’s very similar to that traffic analogy where it just “sort of happened” for seemingly no reason. It’s caused by the fact that it’s a vague, nonlinear, dynamic system.

Dan: What inspired you to write the book, “The Upward Spiral”? Many scientists study depression, but few have written a book for the general public on this subject. What motivated you to create this kind of book?

Dr. Korb: I just realized there is so much useful neuroscience out there that isn’t being effectively shared with the people who need it most. One moment that made me aware of this was while I was coaching Ultimate Frisbee. After a few months, one of the girls on the team confided in me that she had been battling major depression for years, and sadly, many months later, she ended up taking her own life. That event was devastating for me. At the time, I was still studying neuroscience, but I hadn’t yet decided to go to graduate school to focus on depression. It made me want to understand exactly what was happening in her brain that could lead someone to such an extreme action. How could the brain become so stuck in a disease like this?

That led me to go to grad school and work on my dissertation about depression to better understand it and share some insights with others. While working on my dissertation, I realized that although advancing science is valuable, there’s already a lot of excellent research that’s very helpful. I didn’t think anyone was doing a good enough job of clearly explaining what’s happening in the brain during depression and about all the small lifestyle changes that can have measurable effects on brain activity and chemistry.

Dan: The second part of your book focuses on eight specific strategies to help alleviate depression. Briefly, they include exercising your brain, setting goals and making decisions, giving your brain a rest, developing positive habits, biofeedback, creating the ‘gratitude circuit,’ leveraging the power of others, and understanding your brain in therapy. We don’t have enough time to cover all eight, so why don’t we focus on one or two? What I find fascinating is that you provide the background on what’s happening in the brain when you practice these strategies. A few ideas that came to mind were gratitude and your brain in therapy. What about gratitude? How can it help with depression?

Dr. Korb: Gratitude can have many powerful effects on the brain. One reason I wrote this book is that there are plenty of books out there suggesting different life changes to help with depression, but I’ve found that many of them are unsatisfying because they don’t explain why. As a result, they’re less convincing, and it’s easy for people to dismiss them.

So, when I discuss gratitude and how practicing it can be powerful in overcoming depression, many people resist the idea because it sounds hokey. But if I can cite specific neuroscience studies showing it has measurable effects on brain activity and chemistry, you’re more likely to try it, and you’ll better understand what’s happening. Gratitude has been shown to improve sleep quality in people who keep a gratitude journal, and sleep problems are a common cause of depression. I called my book ‘The Upward Spiral’ because depression can be seen as a “downward spiral,” where one symptom or event triggers a cascade of issues that keep you stuck. Gratitude can help break this downward spiral, especially the sleep problems that lead to concentration difficulties, offering a way to interrupt the cycle.

Dan: After reading the chapter on gratitude, I grabbed a spiral notebook and started a gratitude list. It turned into more of a lifelong gratitude list. It’s incredible. I listed eighty things and was surprised. Usually, my experience with depression is that we focus on negative things, and we simply don’t take the time or have the skill to savor and reflect on the good things in our lives. It seems you’re saying this practice affects 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 even more important to develop a habit of seeking out those positive things, because often the most crucial part of gratitude isn’t finding something to be grateful for, but remembering to look for it first. Doing so activates the prefrontal cortex, which is the thinking part of the brain, helping it regulate the emotional regions that tend to go haywire in depression. Gratitude also increases activity in a key brain region called the cingulate cortex, which sits at the intersection of the emotional limbic system and the rational prefrontal cortex, helping to modulate communication between those areas. Recalling happy or grateful moments from your past actually boosts the production of serotonin in that same brain region, and serotonin is one of the main targets of antidepressant medications. Practicing gratitude influences key brain areas involved in depression and the neurotransmitter systems that contribute to it.

Dan: I also found your chapter on our brains and therapy interesting. What’s notable is that many people who see a therapist find comfort and solace in therapy when they are struggling with depression. They leave, often feeling better, but don’t always understand why. We also know there’s a recent study from the National Institute of Mental Health that concluded as many as forty percent of adults in this country who had a recent episode of major depression, whether it’s antidepressants or therapy. So, why is it important, if at all, for people to go to therapy when they struggle with depression?

Dr. Korb: The chapter I wrote on therapy covers more than just psychotherapy – talking to someone – but also includes medical treatments like antidepressant medication and other techniques such as neuromodulation. These methods have been proven through rigorous, double-blind studies to be effective in treating depression. Visiting a professional if you think you are suffering from depression is a crucial step because it allows you to access the latest advances in Western medicine.

What’s interesting – and it’s the last chapter in the book — is how many comments I get, with people saying, “You left antidepressants to the end because it’s not that important and there are other life changes people can make.” Another psychiatrist will tell 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 treating depression, and if you think you are suffering from depression, you should see a health professional, whether it’s your doctor or a psychotherapist. I just don’t believe antidepressants are the entire solution.

For some people, I would say about one-third of those suffering from depression believe antidepressants are the answer. You can get over your depression completely just by taking a pill. You don’t know if you might be one of those people. So, it’s best to 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, changing your sleep habits, or practicing gratitude. As you make the other small life changes, then things can start to spiral upward.

***This is a revised and updated article based on my previous interview with Dr. Korb, his 2025 book, and blog posts from his website.

Copyright, 2026 

Daniel T. Lukasik, Esq.