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Pr. Owen Wolkowitz: Explaining Aging Acceleration In Mental Illness

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Pr. Owen Wolkowitz: Explaining Aging Acceleration In Mental Illness




Hello! You’re on MD-FM INSIGHT, the first medical web radio. Today we’ll be devoting our "Question & Answer" program to biological mechanisms at the cellular level that could be underlying psychiatric illnesses.


People with long-term psychological stress, depression and post-traumatic stress disorder tend to develop earlier, and more serious forms, of physical illnesses that usually hit people in older age: like stroke, dementia or heart disease.  


Scientists are finding that the same chromosomal changes that occur as people age, can also be found in people experiencing major stress and depression and that is: a shortening of the length of telomeres, which are protective coverings at the end of chromosomes, and which have been recognized as playing an important role in aging.


On this topic we met with Pr. Owen Wolkowitz, professor of psychiatry at the university of California in San Francisco –a leading researcher on this topic.


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Hello Dr. Wolkowitz. First of all, can you tell us, in general what factors seem to influence the size of telomeres?



Telomere length is multi-determined. Part of it is genetic, estimates are 30 to 80 percent genetic, but then the rest of it is environmental. And it seems a really important part of that is early life adversity –that can probably cause epigenetic changes to the DNA that can then have life long effects on telomere length but even above and beyond that, things that happen in current life seem to have relationship with DNA as well….




Can you give us examples?



Yes, so chronic psychological stress is associated with shorter telomere length. PTSD is probably associated with shorter telomeres, major depression is probably associated with shorter telomeres… I say probably because it’s really a young field –there’s not that much research yet and, in the case of chronic stress, it’s not just being exposed to stress, it’s how the person reacts to the stress, the person’s mental disposition towards the stress that seems to determine the telomere length.



Ok and this shortening of telomeres, is it a form of aging?



I’m reluctant to say that telomere shortening is the same as aging –it’s associated with aging but it may not be the same... It’s a marker of bad things that are happening to the body, that can also lead to physical diseases like inflammation, oxidative stress, possibly reactions to chronic infections, things like that. But also when cells get shorter telomeres, that can promote aging related diseases because the stem cells die earlier and old immune cells secrete more inflammatory cytokines. So, I think, it goes both ways. I think there is a connection with physical comorbidities. 



And is this phenomenon reversible?



That’s the million-dollar question. Is it reversible? Preliminary data, but it’ very preliminary, suggest that lifestyle changes can lead to increased telomerase activity and maybe to a lengthening of telomeres as well. Things like dietary restriction, taking anti-oxydant supplements, including folates, omega-3 fatty acids, and things like meditation and stress reduction –those all seem to either retard telomere decrease or else actually stabilization or maybe even increases in telomeres. So I think there is hope that it can be reversed.



And in PTSD or depression, at what stage of the affection do you start observing this shortening of telomeres? Is it very early in the process? ..Does it come later?



That’s an excellent question, and the answer is not known. In major depression, most studies suggest there’s a dose response relationship, so the longer you’ve had depression, the more likely you are to have shorter telomeres. That’s most studies. But there are a few studies that show shorter telomeres even at the very first episodes of depression. So my hunch is that it’s probably short at the beginning, maybe with a genetic basis, but then the longer you’ve had depression, the more sharply the trajectory is going down. With PTSD, it’s almost not been studied at all... We have some preliminary data suggesting that the duration of time someone’s lived with PTSD symptoms, the shorter the telomeres, even independent of how much they’ve aged over that time. So I think there is a chronicity correlation.



And is there a link between the inflammation process that’s often noticed in chronic psychiatric illnesses and the shortening of telomeres?



A lot of research is suggesting that chronic low-level inflammation is seen in many psychiatric illnesses. So you wouldn’t necessarily pick it up in a laboratory test, it’s not that high, but it’s higher than it should be, within the normal range… And that is associated with shortening of telomeres. There are quite a few studies showing that. So I think that’s a very important link.



So, what is your take home message for clinicians?



One is that stress and mental illnesses are not purely mental illnesses, they are not even restricted to the brain, but they are associated with the entire body. So I would see depression and PTSD etc. as systemic illnesses not just mental illnesses and clinicians, psychiatrists and psychologists, need to be aware that these diseases affect the whole body that’s number one. Two: that this may provide a good marker for what’s going on in the cells of the body. Three: there may be ways to reverse the acceleration of aging that’s seen in mental illness by things like lifestyle changes for example and perhaps even medication.



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