One of the miracles of life is that no two humans are the same, although we inherit many traits from our ancestry. These traits have evolved over millennia to make us who we are.
Our DNA is like a special recipe book of instructions (nucleotides) that unlock and modify each human characteristic. Through time, our genome has been modified through migration, ethnic intermingling, and numerous environmental factors. Due to this constant adaptation, we all have inherent genetic strengths and weaknesses.
Thanks to recent advances in technology, psychiatric practitioners now have immediate clinical tools to fine-tune their treatments that better match our individual (genetic based) requirements for mental health well being.
Pharmacogenetic
Research has recently revolutionized the accuracy of prescribing psychiatric medications. Previously it was a very “hit or miss” endeavor to find the right drug to alleviate the psychiatric symptoms in a patient. Now, with the help of genetic analysis, we can identify certain variations that help direct the right drug for the right person. Likewise, genetic insights enable the development of drugs targeting specific genetic mutations or pathways associated with mental health disorders.
For example, many psychotropic drugs use liver enzymes to be metabolized. Affordable genetic testing can now tell the practitioner if the patient has a slow, fast or ultra-fast metabolism of drugs using a certain enzyme. If the drug is broken down slowly, it may result in the need to lower the dosage to avoid a build-up and side effects of the drug in the patient. If metabolized quickly, a higher dosage might be needed. And if ultra-fast (due to extra copies of the gene), the drug might be metabolized so quickly that no effect is seen at all.
Training in the use of “Precision Medicine Software” is incorporated into the fellowship of Psychiatry Redefined, so that practitioners can guide psychotropic treatment in a much more targeted and accurate manner. The use of certain drugs might be chosen over another based on this testing, or dosages modified to better meet individual needs.
Targeted Therapies
Genetic insights also enable the identification of complementary interventions targeting specific genetic mutations or pathways associated with mental health disorders.
Nutritional genomics, also known as nutrigenomics, is a science studying the relationship between human genome, human nutrition and health.
DNA sequencing is as easy as a cheek swab and costs only a few hundred dollars. Some tests are made using standard labs and included under health insurance. The DNA sequencing method is used to determine the order of nucleotides (A, T, C, G) in a DNA molecule. It reveals the genetic code, which contains instructions for building and functioning of an organism. It involves reading the sequence of bases in a DNA strand.
Think of DNA gene sequencing like reading a cookbook. For example, the MTHFR gene provides instructions for making an enzyme to process the B vitamin “folate” which is important for DNA synthesis and methylation: a process crucial for many bodily functions, including the regulation of important messengers (neurotransmitters) in the brain.
By knowing the MTHFR status of a patient, a practitioner can provide the advanced forms of this vitamin where needed, resulting in better brain function, alleviating depression (and better response to antidepressants), and often alleviating many more symptoms.
The gene variant COMT for one variant (rs4680) has had more than 400 studies published directly related to psychiatry. COMT stands for Catechol-O-methyltransferase, and it is a protein that plays a role in the breakdown of neurotransmitters like dopamine. This enzyme helps regulate the levels of these neurotransmitters, which are important for various physiological and cognitive functions. Knowing the patient’s genetic sequence of COMT can help determine underpinnings of mood disorders and direct more accurate treatments.
Instructing practitioners on how to arrange testing of their patients, how to identify key variances and how to treat them with nutraceuticals is a crucial component of the coursework in Psychiatry Redefined.
Heritability of Mental Illness
We now know that most psychiatric illnesses are strongly heritable, meaning they are passed down in families. We also know that they are highly “polygenetic”, meaning it takes many genetic variants in certain concert together – and combined with many environmental factors, for mental illness to manifest.
For example, about 70% of the risk of developing schizophrenia is genetic. This does not mean, however, that if a parent has schizophrenia their child will develop it. Environment plays a key factor in mental health, and we are just learning how the environment can change our gene expression and influence biological imbalances leading to such disorders.
Epigenetics
This is the field of study that examines the environmental factors that can influence gene expression. The environment doesn’t change the underlying DNA sequence – as we can measure in genome sequencing, but it does affect how genes are turned on or off, which can have significant effects on an individual’s mental health and well-being. Through a technique called “Gene Expression Profiling”, researchers are measuring molecules produced when a gene is expressed.
While “genetic sequencing” defines the recipe book, “genetic profiling” sees which actual recipes are being used at a particular time. DNA sequencing is like reading the recipe book, and genetic profiling reads the chef’s shopping list and prep instructions (RNA).
When you want to cook something, you don’t take the entire recipe book to the store. Instead, you make a list of the specific ingredients you need. This list (RNA) is made based on the instructions in the recipe book (DNA). RNA carries the specific information from the DNA to the kitchen (the cell), where it’s used to gather and assemble the ingredients (amino acids) needed to make a particular dish (protein).
In a similar way, RNA in our cells carries out the instructions encoded in our DNA to create the proteins that carry out various functions in our bodies. The area of epigenetics is important in psychiatry because many environmental factors can impact these messengers and “turn on” or “turn off” genes. When these instructions get confused (or deregulated), biological pathways also become imbalanced. In this scenario mood, perception and cognition can become altered, and any number of psychiatric illnesses can result or be exacerbated.
Personalized Treatment
At Psychiatry Redefined, practitioners use functional and genetic testing to identify environmental factors which can impact biological pathways and impact mood. These environmental (epigenetic) factors can include: infection, chemical contaminants or hard metals such as aluminum or mercury, microbiome imbalances, and exposure to stressful events, including trauma. Knowing how to read these test results, key interventions can be identified that are more individually tailored and therefore effective.
With genetic sequencing information, such as MTHFR and COMT status, and knowledge of particular environmental (and family related) risk factors, practitioners can target particular compounds that can alleviate weaknesses in these genes. At Psychiatry Redefined, practitioners learn how to use amino acids, and micronutrients such as vitamins and minerals, and adaptogen herbs. These therapies can positively impact the biology of individuals, and by bypassing genetic glitches they can restore homeostasis.
In our Fellowship curriculum, we examine these new clinical practical tools. With a deeper understanding of genetics, practitioners begin to see the underlying causes of psychiatric illness. Through the use of pharmacogenetic testing, they can prescribe more accurately – and with this use of targeted complementary medicine, they can then treat more effectively, often providing dramatic and lasting improvements for their patients.
