Questions about Mental Health, Drugs, and Genetics
If you have been following my blogs on Mental Illness and the Church, you will realize that I too am on a journey for answers in a complex and misunderstood world of Mental Health, especially when it comes to dealing with my own Christian faith, looking for answers which I will address in tomorrow’s blog. For today, lets look at the psychiatric drug world and the world of genetics for answers, or more questions!
I hear much from the psychiatric world and drug company world with lists of numerous drugs for a large variety of mental illness. TV is inundated with commercials about psychotic medications that you are to “ask your doctor about” while listing side effects that take up 2/3rds of the commercial. The list of side effects covers pages in magazine adds as well as print outs from the pharmacist. As the horror of institutionalization was in the 20th century for many people facing mental illness, side effects to psychiatric medication are producing this centuries horror stories.
In a comment on line to the Charlie Rose program on Mental Illness discuss in my last blog “oypol” commented: “I was never made aware that Benzodiazepines were, in fact, tranquilizers. Had I known that, I would have never taken my first pill. Ever. I was led to believe benzos were a new class of drug – for treating anxiety. I was addicted, latrogenically addicted….. Benzodiazepines are dangerous drugs when given long term, and cause a host of negative symptoms. Doctors tell patients they need them like a diabetic needs insulin. What? Does anyone NEED addictive substances for life? Would they tell an alcoholic they need vodka for the rest of their lives? No! ….. The negative symptoms from these drugs should be labeled as such. Calling them “side effects” minimizes and sugar coats the impact. These aren’t side effects. They are DIRECT EFFECTS that a patient would not be experiencing, were it not for the chemical they are ingesting. “
So medically, what I thought was answers, instead raised multiple questions about safety, longevity, and care for my loved one taking medication to which they have been told they are dependent upon for life.
The new hope is genetic research where mutant genes can be identified that may be the cause to many of these mental disorders. Charlie Rose interviewed Stephen Warren whose research helped isolate the gene responsible for fragile x syndrome. He is now studying the genetic basis for major psychiatric disorders. The following is from the excerpts from the transcript of this show.
CHARLIE ROSE: Steve Warren, what about the genetic underlying of this in heredity?
STEPHEN WARREN, EMORY UNIVERSITY: So we know genetics plays a role by looking at family histories. So something like schizophrenia occurs in one percent in the normal population, but if you have a sibling with schizophrenia then your risk goes up to about nine percent.
Even more striking is if you look at identical twins. They share 100 percent of their genome and the risk now is nearly 50 percent.
What’s important is it’s not 100 percent like it is with a simple genetic trait like cystic fibrosis where identical twins, both twins, would always have the same disorder. Here half are discordant or don’t share that disease. That says, then, that there’s other factors playing a role like environmental factors.
You can see also looking at non-identical twins who are essentially just siblings but yet they have a higher risk than normal siblings because they share more of an environment.
So we think of complex disease as now having contributions of the genome as well as contributions of the environment. Usually it’s easier finding the genetic factors first and then trying to sort out of the environment.
CHARLIE ROSE: Even though there’s a lot of genes involved here.
STEPHEN WARREN: Well, the problem is we know it’s not one gene, we don’t know how many genes, but it’s probably a handful of genes. But we what we’re learning in the last several years is that the brain, unlike many other organs, presents an enormous -- what we call a mutational
target.
There’s so many proteins that contribute to how the brain works that if you disrupt any one of them, you might having a similar outcome. And so the different genes might all lead to the same phenotype, so it gets to be kind of a hard thing to narrow down.
But it’s complicated, but I think now with the new technologies that have been emerged in the last couple years, sequencing, being able to sequence genomes rather cheaply and other technologies, that at least gives us optimism that we’ll be able to identify these genes in the future.
CHARLIE ROSE: What do you think, Steve?
STEPHEN WARREN: What we’d like to do is to be able to identify the genes that would predispose an individual to these disorders prior to onset so then they can be perhaps more responsive to therapeutics and prevent the onset of --
CHARLIE ROSE: And how are we going on that?
STEPHEN WARREN: Well, we’re coming along. I think the idea is to identify a few genes that play a big role, and that gives us a toehold into the biochemistry of what’s going on in the brain. It’s just like Elyn said. There’s a lot of circuits and pathways where the genes are contributing.
So it’s a highway with every gene is the stoplight or the stop sign, and each individual gene can be changed. But it has the same affect on how the traffic flows. And that’s part of the difficulty in identifying these genes is it’s so complex. If you just look at the synapse alone, there are
hundreds and hundreds of pro proteins that interact.
CHARLIE ROSE: So in everything we’re talking about here in terms of depression and disorder and schizophrenia, we’re all talking about treatment so far. Where is cure?
JEFFREY LIEBERMAN: Cure is really not immediately on the horizon. But the illnesses, if they’re identified promptly and treated effectively, can be stopped in their tracks. So we’re talking about remission, which is within our grasp, if we simply get our act in order. In terms of cure, cure will depend on the identification of the genes and the ability to preempt the illness prior to the onset.
CHARLIE ROSE: Prevention. Prevention.
ERIC KANDEL: Absolutely. But there’s an important thing, Charlie, to realize. And that is many illnesses are like this. There is no cure for diabetes. It’s a lifelong illness. There is no cure for hypertension. There are dozens of diseases that you can name. In fact, most of the common diseases, it’s a question of good therapy and then maintaining that therapy with watchful waiting. And we see two spectacularly rich lives here of people who still suffer from the disease, but it’s under very good control.
So I think one has to come to grips with the fact that for a long time we will not be able to have cures but that doesn’t mean one doesn’t have essentially the effective cures. That is people living with the disease, struggling periodically, but most of the time being able to lead a rich life.
CHARLIE ROSE: What is the question you most want the answer to?
Stephen Warren, Emery UniversitySTEPHEN WARREN: Well, and same answer, too, probably. To go from a gene to behavior and understand all the steps in between is just -- would be fantastic, particularly something as come complex as a psychiatric disease.
Wow, more questions than answers, so those facing mental illness still have to live on hope, hope for the future to come up with these answers. It was the first time I have ever heard to words “prevention” used with Mental Health, so maybe we are on some breakthroughs at how we will look at mental illness, particularly if it is genetic, and we know it is hereditary.
The Bible looks at faith, hope, and love, and tomorrow we will take a glimpse of the questions and answers from the spiritual side of things.