Let’s discuss social influences which play role in the development of depression or PTSD in patients with a history of trauma

We must be clear that genetics is not necessarily destiny. That genetics can be overcome, and gene expression can be modulated – Dr. Charles Nemeroff

So I was just listening to a podcast “Psyched!” with an episode titled “Abuse, Attachment, and Resilience: Genes and the Environment” hosted by Dr. David Carreon and Dr. Jessica Gold.

It’s a Part 2 of the previous podcast which I discussed earlier here.

The guest of the episode was Dr. Charles Nemeroff, a renowned psychiatrist who is currently working as the Director of University of Miami Center on Aging and Chairman of the Department of Psychaitry and Behavioral Sciences at University of Miami.

Following are the keypoints of the podcast:

Early life trauma (mostly pre-pubertal age) is associated with a very persistent increase in inflammatory markers, and it’s probably one of the reasons why those patients have a poorer response to psychotherapy and pharmacotherapy.

The human brain doesn’t mature until age 24, and we know that developing protoplasm is susceptible to insult. Susceptible to lead toxicity, susceptible to fetal alcohol, and in my way of thinking, it’s susceptible to behavioral teratology, namely child abuse and neglect.

For major depression, about 35 to 40% of the risk for the disease is genetic. That means 60 to 65% is environmental, and a lot of this has to do with attachment. Dr. Nemeroff thinks thst early life trauma disrupts attachment, and subsequent life stressors disrupt attachment, and if you follow these kids who’ve had terrible early lives, it’s a very rocky adolescence and adulthood indeed.

There are some critical genes, which if modified, markedly increase your risk for depression if you’ve been exposed to early trauma, and then their counterparts which are resilience genes that prevent it.

What’s really interesting is in our studies, in the absence of early life trauma, these genetic variants have no impact on whether you get depressed or not. It’s only in the face of early life trauma. It’s sort of like … Imagine the guy who has the risk gene for lung cancer but never smokes, right? No effect, right? But smokes three packs a day and 80% likelihood.

Every study of efficacy of psychotherapy has always had the same conclusion, which is it’s the quality of the relationship between the psychotherapist and the patient that is the best predictor of outcome, regardless of whether you’re using cognitive behavior therapy, interpersonal psychotherapy or psychodynamic psychotherapy.

In the next 10 years there’s gonna be a sea change in terms of treatment. We’re gonna develop personalized medicine in psychiatry. You’re gonna see a patient, you’re gonna get their genetics, you’re gonna probably get imaging on them, you’re gonna get inflammatory markers and based on those results, you’ll be able to optimally match them to the best treatment and not have to play trial and error. That’s gonna be a whole new world for us.

To listen to the full podcast, click the link here.

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