Epigenetics as an Integrative Approach to Mental Health

Dr. Winsome Christie
President
 Pharmaceutical Society of Jamaica

 What is Integrative Healthcare?

Integrative healthcare emphasizes a holistic, patient-focused approach to health care and wellness—often including mental, emotional, physical, social and also spiritual. Integrative psychiatry is the holistic approach that uses both conventional and complementary therapies in the treatment of psychiatric disorders. Personalized treatments are developed to suit each person's lifestyle and strengthen self-awareness and resources for self-care.

What is Epigenetics?

Epigenetics is an emerging scientific field that studies heritable changes caused by the activation and deactivation

Natasha Grey - Pharmacy Intern

of genes without any change in the underlying DNA sequence of the organism. It is a mechanism in which chemical compounds are added to genes and affect the way genes code for proteins. This involves how our current genetic codes are modified to express or not express itself without causing a change in the code itself (it is not a form of mutation).

Epigenetic changes affect an individual’s phenotype (the result of gene expression), but does not change the genotype (the DNA responsible for that particular characteristic).

Take for example twins, they have the same genes (same DNA) and usually grow in similar environments. Even then, there will be differences due to epigenetic modifications. Identical twins have identical genomes, but different epigenomes (change to the DNA). The changes are based on contributory factors. Epigenetics looks at the micro switches that make the genes express itself or not express itself.

Contributory factors in Epigenetics

• Environmental influences
• Diet
• Age
•  Exercise
• Stress level
• Smoking
•  Infections

Example of Epigenetics - DNA Methylation

One example of epigenetics is DNA methylation. Methylation is the insertion of a methyl group into DNA. It locks the gene in the “off” position i.e. it silences the gene causing it to not be expressed. The maintenance of this is crucial for normal neurodevelopment and functioning of the brain. As it relates to mental health, methylation can cause the heritable gene of a psychiatric disorder to be silenced and not cause the individual to develop that particular mental disorder.

The Effect of Diet in DNA-Methylation

Diet plays a crucial role in how the body reacts in the future. It is our building block. Nutrients such as folic acid, vitamin B12 and SAM-e (S-adenosyl methionine) are key components of the methyl making pathway. These specific nutrients can keep the gene in their proper on or off positions so as to reduce illnesses (Apsell, 2008). Examples of nutrients which may cause methylation are flavonoids, from fruit, resveratrol, fushimi from sweet peppers, kiwi, Vitamin E, Vitamin C and isothiocyanates (from blueberries). Methionine is a beneficial chemical that can be found in spinach, garlic, brazil nuts, kidney beans and tofu (Christie, 2010).

Genetics in Psychiatry

The genetic codes that we inherit are essential. However, variations do not necessarily ‘cause’ the disease but rather influence a person’s susceptibility to environmental factors. All human diseases result from the interaction of genetic susceptibility and the modifiable environmental factors (CDC: The Office of Genetic and Disease Prevention, 2000). Genes alone cannot be used to diagnose mental illness, and so, researchers opted to use epigenetics to predict vulnerability to mental illnesses such as depression, Post Traumatic Stress Disorder(PTSD), anxiety etc. Researchers believe that the most important contributory factors which lead to poor mental health are diet and nutrition and past experiences.

Adverse Childhood Experiences (ACE)

These are traumatic past events which affect a person’s behaviour, growth and development. It has a lifelong impact on physical and mental health. These include abuse, neglect, domestic violence, crime, alcoholism etc.

A study surveyed 17,000 adult HMO patients who had mental illnesses. It was found that ACEs correlate with negative outcomes in memory, it caused substance abuse, aggression, anxiety and sexual disorders (Felitti, V Eur Arch Psychiatry Clin Neuroscience 2006, 256 (3):174-86).

Abuse creates epigenetic change in the Hypothalamic Pituitary Adrenal (HPA) axis ACEs have been associated with alteration of the HPA axis due to stress responses. Stress response activates structures in the brain like Amygdala, which activates the HPA axis. It then creates a cascade that releases cortisol. Cortisol goes throughout the body, increases glucose metabolism and boosts energy. Prolonged stress may cause continuous production of cortisol. This is exhausting to the body and may cause the neurotransmitters in the brain, -like serotonin ie. the chemical that influences mood, appetite, and sleep—to stop functioning correctly, potentially leading to depression.

Relevance to Pharmacy

It is essential for pharmacists to be aware of the latest developments in the field of epigenetics and pharmacoepigenetics in order to optimize disease-state management. As pharmacists, we are now able to improve patient counselling; and give advice on diet and lifestyle to improve patient’s quality of life.

As pharmacists we can recognise that Mental Health issues include:

• Complex Patterns
• Multi-faceted causes
• Power of Mind and Spirit
• Relational Foundations
• Self-correcting Powers
• Mental/Emotional/Spiritual Homeostasis
• Mental Healthcare needs to be:
• Collaborative in practice
• There needs to be listening and listening some more
• Needs vs want analysis
• Decision making as real partners
• Provide choices
• “Empowering the Patient”

We need to recognize the developmental  nature of Mental Healthcare.

•We grow from one cell, we reach an incredible level of complexity

•We are plastic and ever changing

•The nervous system rewires in response to the setting and demand

•Integration as frontal lobe capacity

•Nutrition, environment, family

•Illness? or deficit of nutrient, skill or nurturing

Finally, Mental Health needs to be Humanistic in approach involving:

•  Care
• Support
•  Inspirational and motivational
• with Empowerment being a crucial concept

Important Point

Proper nutrition and lower stress levels are important factors in preventing a mental disorder and should be monitored to prevent mental illnesses especially in those who are predisposed to these conditions.

Authors

Dr. Winsome Christie (President, PSJ)

Natasha Grey (Pharmacy Intern)

References

CDC. (August, 2000). The Office of Genetic and Disease Prevention.

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College of Natural Health Alabama: Dragon’s Medical Bulletin

Goud Alladi, C., Etain, B., Bellivier, F., & Marie-Claire, C. (2018). DNA Methylation as a

Biomarker of Treatment Response Variability in Serious Mental Illnesses: A Systematic Review Focused on Bipolar Disorder, Schizophrenia, and Major Depressive Disorder. International journal of molecular sciences, 19(10), 3026. https://doi.org/10.3390/ijms19103026

Jiang, S., Postovit, L., Cattaneo, A., Binder, E. B., & Aitchison, K. J. (2019). Epigenetic Modifications in Stress Response Genes Associated With Childhood Trauma. Frontiers in psychiatry, 10, 808. https://doi.org/10.3389/fpsyt.2019.00808

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