Front Matter

Contributors vii

Preface ix

Acknowledgments xi

1 Overview of Genetic and Epigenetic Mechanisms 1

2 Epigenetic Modulation in Major Depressive Disorder 39

3 Epigenetics in Neurodevelopmental and Neurodegenerative Disorders 59

4 Epigenetics of Childhood Trauma and Resilience 103

5 Epigenetics of Lifestyle and Aging 133

Glossary 153

Index 169

Associate Director, Psychiatry Residency; Assistant Professor of Psychiatry; Director of Psychotherapy Training; Director of Ambulatory Behavioral Health Services, Central Michigan University College of Medicine, CMU Medical Education Partners, Saginaw, Michigan

Clinical Assistant Professor of Psychiatry, Central Michigan University College of Medicine, CMU Medical Education Partners, Saginaw, Michigan

Resident Physician, Beaumont Psychiatry Residency, Beaumont Health, Dearborn, Michigan

Previously, University of California Davis School of Medicine, Department of Medical Microbiology and Immunology, Davis, California

Clinical Assistant Professor of Psychiatry, Central Michigan University College of Medicine, CMU Medical Education Partners, Saginaw, Michigan

Epigenetics is growing. As geneticists and biologists extend our knowledge of the cellular concepts and molecular phenomena that affect gene expression without changing the gene sequence, the science is expanding into other areas. Developmental trajectories, environmental effects on gene expression, and inherited phenotypes rely heavily on epigenetic mechanisms. The field of medicine has found novel applications of epigenetics in better understanding how pathology develops and the potential for characterizing—and in some cases producing—novel treatments.

The field of psychiatry is no exception. The study of epigenetics has grafted itself onto this branch of medicine, fostering new perspectives for understanding neurodevelopment across the life span, including neurodevelopmental and neurodegenerative disorders, family dynamics and shared environments, effects of trauma and life stressors, resilience, mood disorders, and the influence of lifestyle factors on healthy aging. The recognized impact of epigenetics is also represented in questions on in-training, licensing, and board exams. As it adds to our understanding of how pathology arises, epigenetics also provides fresh perspectives on interventions that may revitalize hope for providing relief to patients seeking our help.

That being said, the rate of growth of epigenetics in the field of psychiatry is outpacing the average psychiatric practitioner’s level of familiarity with the topic. To understand the applications of epigenetics to our field, practicing psychiatrists, nurse practitioners, physician assistants, psychologists, trainees, and students increasingly encounter clinical research that is remarkably complex, encompassing epigenetic mechanisms and pathways that are outside the scope of their preclinical training.

This book is a resource to the behavioral health or psychiatric practitioner who is interested in keeping up with the field of applied epigenetics within psychiatry. The first chapter, “Overview of Genetic and Epigenetic Mechanisms,” provides a refresher on genetic mechanisms necessary to grasp the core concepts and machinery of epigenetics. The chapter is by no means comprehensive, as it is intended for an audience that has previously completed coursework in genetics and molecular biology, but it includes a concise review of all the major concepts that arise in current applications of epigenetics in psychiatry. Much more detailed information is available in outside sources, but the content presented here is discussed at a level which, if mastered, will provide a sufficient understanding for the reader to dive with confidence into new literature on the topic.

The next chapters provide overviews of how epigenetics has improved our understanding of specific clinical aspects in psychiatry: mood disorders with a focus on depression (Chapter 2, “Epigenetic Modulation in Major Depressive Disorder”); neurological disorders (Chapter 3, “Epigenetics in Neurodevelopmental and Neurodegenerative Disorders”); trauma, toxic stress, and resilience (Chapter 4, “Epigenetics of Childhood Trauma and Resilience”); and health-promoting behaviors (Chapter 5, “Epigenetics of Lifestyle and Aging”). The goal for this book is not for readers to become experts in epigenetics in psychiatry, but rather for physicians and providers to fill the gaps in their knowledge of the core science of epigenetics enough to confidently approach and comfortably grasp current and future research in pathology and treatment of psychiatric disorders.

 

A note about language. We recognize the expansive and nonbinary nature of human gender expression. In this book, without yet having a clear alternative, we use traditional binary terms such as male/female and maternal/paternal, but we support proposals for more inclusive language.

Turning an idea into a book is an experience that is both internally challenging and rewarding. I especially want to thank the individuals who provided support in various capacities in making a reality out of this book. To my wife (Samantha Edeh), thank you for always being there for me and for always supporting my dreams. Your frequent reminders and encouragements are unparalleled and kept the motivation during the entire process. I want to give honor to my alma mater, the University of Ibadan, Nigeria, for a well-grounded educational support and for nurturing my interest in science and fostering positive values. THANK YOU. The world of medicine is a better place thanks to mentors who take the time to share the gift of knowledge with future doctors. Special thanks to Dr. John Covault and Dr. Debra Forrest of the University of Connecticut; Dr. Molly Wimbiscus and Dr. Tatiana Falcone of the Cleveland Clinic; and Dr. Asif Khan of Central Michigan University College of Medicine, who provided encouragement and insight through this process.