Know Your Family’s Mental Health History

A combination of genes and environmental factors affect your risk of developing a range of psychological or neurological conditions.

Knowing your family’s medical history requires more than a grasp of who had heart disease or cancer. If you have a family history of mental illness or neurological diseases, sharing that information with your doctor can be very helpful if you ever develop symptoms of such conditions.

That’s because many mental health disorders and neurological problems have some degree of heritability, explains psychiatrist Gregory Fricchione, MD, director of the Division of Psychiatry and Medicine at Massachusetts General Hospital (MGH) and director of the Benson-Henry Institute for Mind Body Medicine at MGH. A person with a strong family history of generalized anxiety disorder (GAD), as an example, may be more likely to develop symptoms of that condition or any of several other anxiety disorders.

“There’s something to this idea of familial risk,” Dr. Fricchione says. “But with many neuropsychiatric disorders the genetic risk component is due to a mosaic of different gene changes. So what do we do with this? We don’t have a gene replacement treatment if someone is at risk, and giving a drug with side effects for risk alone is usually not indicated.”

But as the saying goes, knowledge is power. And the more knowledge you have about your familial risk for certain psychological or neurological conditions, the more power you and your doctor have when it comes to diagnosing and treating a disorder, or helping to prevent or delay its onset.

Take Action Now

A family history of Alzheimer’s disease, Parkinson’s disease, depression, anxiety, addiction and other cognitive and emotional disorders doesn’t mean your health future is already written. It does mean that your risk of developing a particular condition may be higher than it would be if there were no family history.

So just as you might try harder to live a heart-healthy lifestyle if you had a parent with heart disease, you should also consider a family history of mental and neurological disorders as motivation to manage the risk factors in your control. While you can’t control your genetic profile, your age, sex, and the environment in which you were raised, you can take steps to help keep your brain as healthy as possible. That means, among other lifestyle choices:

  • Quit smoking. Talk with your doctor about therapies that may help you quit if you currently smoke.
  • Maintain a healthy weight; both frailty and obesity can contribute to emotional and cognitive complications.
  • Follow a healthy diet that focuses mostly on vegetables, fruits, whole grains, lean proteins, and low-fat or fat-free dairy.
  •  Limit alcohol intake to one drink a day. Excessive alcohol consumption is a risk factor for many cognitive- and mood-related problems.
  • Exercise 30 to 40 minutes most days of the week, or every day.
  • Keep up with your regular doctor appointments and screenings, including regular physicals, blood work, and dental, vision and hearing checks.
  • Take your medications as prescribed by your doctor.
  • Aim for at least seven or eight hours of sleep every night.
  • Keep your brain challenged by reading, taking a class, learning a language or a musical instrument, doing puzzles, traveling or other mentally engaging activities.
  • Maintain a healthy social support network.
  • Cultivate a positive attitude replete with optimism, purpose, meaning, gratitude and forgiveness as much as possible, and keep your sense of humor intact.
  • Avoid the lure of negative thinking, which can culminate far too often in catastrophizing.

Dr. Fricchione adds one more very important lifestyle suggestion: Elicit the relaxation response through the daily practice of a meditation like mindfulness. High stress levels can contribute to a range of cognitive and emotional problems, regardless of whether you have inherited the genes that elevate your risks. “It’s important to understand the ingredients that go into stress and resilience,” Dr. Fricchione says. “Proper nutrition, sleep hygiene, exercise, and all those healthy behaviors and resilience-building factors can have a positive impact on cognition and mood and may help promote overall health and prevent or at least delay the onset of stress-related, chronic illnesses, including neuropsychiatric ones.”

Inheritance and Environment

Reducing your stress and following a healthy lifestyle can’t guarantee a long life free of disease or struggle. But it can give you the best odds of minimizing health problems later on.

Mental health disorders, like many physical health issues, are the results of genetic and multiple environmental or lifestyle factors. You may inherit certain genes that predispose you to a particular condition, but they may never affect your health. Certain genes need to be “switched on” by environmental factors in order to effect any change. This “epigenetic” regulation changes over the course of your life. Stress is a major environmental risk factor that can trigger gene activity.

“Environmental risk factors will activate certain genes and/or reduce activation in other genes. “ Dr. Fricchione says.

In some cases, it’s a missing gene or a gene mutation that is the cause of a neurological or emotional condition. “Diseases related to hard-nosed, single gene mutations, so-called inborn errors of metabolism, are at one end of the spectrum,” Dr. Fricchione explains. “Everything else is a complex mix of genetics and environment.”

Of course, it’s important to remember that some mental disorders can develop without any family history. A person can be the first in his or her family to develop Alzheimer’s, depression or any condition.

Looking Ahead

Researchers are continuing to learn more about how genetics, environment, and other factors influence brain health, mood disorders, and much more. Several studies have shown that traumatic events or physical health problems early in your life may trigger epigenetic changes that affect the genes. There may even be intergenerational transmission of these effects in germ cells. While this may come as unwelcome news, these new findings provide an opening into the complex intersection of genetics and environmental factors.

The potential use of pluripotent stem cells to bypass epigenetic damage or the use of new gene-modifying technologies like CRISPR along with a deeper understanding of the relationship between environment and inheritance could one day help prevent someone from reliving a family history of devastating mental and cognitive illnesses. “This research in epigenetics, while still in its infancy, will be enormously important moving forward,” Dr. Fricchione says. “It’s an incredibly exciting time.” MMM


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