Panel: Mental Health a Complex Combo of Genetics, Biology, Environment

MAY 9, 2014—What explains the ability of a 94-year-old brain injury victim to recover fully in just a few weeks, while a healthy 35-year-old who sustained a similar injury might suffer the effects for several months or a year?

Not surprisingly, the answer to this question and many others involving mental health is complex and multifactorial, involving a host of variables including genetics, biology, environmental factors and social factors. It turns out that the “hardwiring” of the human brain is just the tip of the iceberg in mental health. It’s the interplay of brain circuitry with an array of other factors that yields the true picture.

This according to a panel at “Doctors Speak Out,” a quarterly series hosted by Georgetown University Medical Center (GUMC) that connects health and medicine experts with the community.

Four mental health specialists, with expertise in psychiatry, traumatic brain injury and concussion, and psychiatric genetics, joined the May 8 discussion called “What’s on Your Mind and Why: How the World We Live In Influences Your Mental Health.”

Panelists were: Steven A. Epstein, MD , chair and professor in the department of psychiatry at GUMC and chief of service of the department of psychiatry at MedStar Georgetown University Hospital; Ayman Fanous, MD , associate professor of psychiatry at GUMC and chief of the Psychiatric Genetics Research Program at the Washington DC VA Medical Center; and Marilyn Kraus, MD , associate professor in the department of rehabilitation medicine at GUMC and director of the concussion program at MedStar National Rehabilitation Hospital.

Rear Admiral Susan J. Blumenthal, MD, MPA , former U.S. assistant surgeon general and current a senior fellow at the New America Foundation, public health editor of the Huffington Post and clinical professor of psychiatry at GUMC, served as moderator.

Nature versus Nurture

The panelists agreed that research has come a long way in terms of illuminating the interplay between genes, biology, and the environment, including social factors for mental disorders that affect one out of five Americans. Yet understanding just how all these variables interact is still largely a mystery.

“There is good news and bad news. We do understand that most mental illnesses have genetic underpinning and are precipitated by stress. More good news is that we have a lot more understanding of genetics and biology,” Epstein said. “But the bad news is that we don’t exactly understand why a given patient might have the problems she has—and that has major treatment implications.”

Fanous added that the relative influence of nature versus nurture varies depending on the illness. And the sequencing of the human genome has revealed that genetics play a critical role—but quantifying that role is still just out of reach.

“When I was in medical school, the hope was that we would find one gene for schizophrenia, one gene for bipolar disorder, one gene for autism. But over the last couple of decades … we have found the picture is much more complicated than that,” he said. “There are hundreds—if not thousands—of changes in the genome sequence that could increase the risk for various mental illnesses.”

Because researchers have not been able to pinpoint the contribution of just one gene, as they have with diseases such as cystic fibrosis and Tay-Sachs, developing therapies for mental illnesses presents a greater challenge.

“In 1961, our nation launched a mission to the moon. Today, we need a mission to the mind. Finding effective strategies to treat and prevent mental illness and end needless suffering caused by these disorders is the moonshot of our generation,” Blumenthal said.

Brain’s Response to Injury and Illness

For patients with traumatic brain injury or concussion, the time it takes to recover can cause additional psychological stress—and possibly exacerbate their condition. Some people are born with brains that respond better to injury than others.

“We think the genetic issue does play a role and that certain people’s brains just don’t do as well after an insult,” Kraus said. “The exact role we are still figuring out.”

When it comes to brain injury recovery time, “everyone brings their own unique brain and physical makeup with them that will affect their outcomes,” she said.

Likewise, some people diagnosed with major physical illnesses, such as cancer or HIV, are much more vulnerable to depression or anxiety than others.

Treatment strategies must reflect the multifactorial nature of mental disease and disorders, Epstein said. For this reason, he advocates a “biopsychosocial” approach to treatment that considers physical, mental and social factors.

While there is yet no surefire prevention for mental disease or disorders, research has shown that activating the pleasure centers of the brain can help.

“If there is one thing that you can do in addition to exercising, it is to look at the things that give you pleasure and make a major effort to schedule them,” Epstein said.

Celebrating Five Years

The session marked the fifth-year anniversary of “Doctors Speak Out”. Since its inception, there have been 19 programs, 53 panelists, 92 advocates and 17 countries represented. More than 2,000 guests have attended the panel discussions on a variety of health topics, according to Alma Gildenhorn, a member of the executive committee for the series.

Gildenhorn lauded the program for spawning Partners in Research, a community-driven philanthropy program whereby donors directly choose the research they wish to fund. In its three years, Partners in Research has raised $245,000 to fund a total of seven projects.

By Lauren Wolkoff
GUMC Communications