Do People With Mental Illness Age Faster Than People Who Are Unaffected?

Last week I attended a talk by Dr. Owen Wolkowitz, psychiatrist and professor at UCSF Langley Porter Institute.  His answer to this question is “yes.”  He refers to mental illness as “disorders of the whole body.”

There is data that people with mental illness die, on an average, 25 years earlier than people in the general population.  30-40% of people with mental illness die of suicide or accidents, but the remaining 60% die of natural causes earlier than the general population.

There are some obvious reasons as to why:

1)      Poor lifestyle – smoking , drinking, illicit drug use, bad nutrition

2)      Poor access to healthcare, poor medication compliance, homelessness

3)      Medication side effects such as obesity, increased lipids

Less obvious are some of the behind the scenes factors, such as inflammation due to stress.

It is also possible that mental illness actually changes our DNA, in particular our telomeres. Telomeres are the pieces of DNA at the ends of the chromosomes. Each time a cell divides, it duplicates its chromosomes, and a little bit of the end of the chromosome is lost. At some point, too much information is lost, and instead of dividing, the cell dies. This is the aging process in a nutshell. We can’t have cells that live forever (that’s what happens in cancer, the mechanism gets screwed up and the cell keeps dividing forever.)  Telomerase, the enzyme that adds the telomeres to the end of the chromosome, can be measured in the blood, and can be used as a marker for aging.

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Studies have been done on telomeres of people with mental illness. Studies of people with depression show telomere shortening. Adults with early life trauma have shorter telomeres, demonstrating perhaps a “scar in the brain.”  There’s evidence that people with schizophrenia who take anti-psychotic meds have longer telomeres than people with schizophrenia who aren’t taking any medication- demonstrating a potential benefit of medication. It’s possible that anti-psychotics can have an effect by reducing inflammation and oxidative stress.

The good news is that telomeres can lengthen. Factors known to extend telomere length to a healthy level include exercise, dietary restraint, multivitamins, folate, Omega 3’s, stress management, statins, estrogen and social support. So while good nutrition, good sleep, exercise and avoidance of illicit drugs are good plans for everyone, they are especially important for people with mental illness, or people at risk for mental illness.

Link to article on telemore shortening:

http://www.sciencedirect.com/science/article/pii/S0006322306001363

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Is There A Link Between Football and Suicide?

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Last night Frontline aired the documentary “League of Denial: The NFL’s Concussion Crisis”, a report about the connection between chronic traumatic encephalopathy (CTE) and football. CTE is is a form of encephalopathy, a progressive degenerative brain disease, which can only be definitively diagnosed after death in individuals with a history of multiple concussions and other forms of head injury.  This disease is known in boxers who receive multiple blows to the head during their careers. A debate ensues as to whether other athletes who receive multiple concussions and minor traumas over the course of their careers, such as football players and wrestlers, are also subject to brain damage as a result.

The documentary presents evidence that brain damage can result from multiple “sub-concussions” over time, and investigates as to whether the NFL knew about the evidence, ignored it, and failed to provide this information to professional football players.

In the documentary we are told about football players who committed suicide, such as Junior Seau, and players who suffered from depression and dementia, such as Mike Webster.  Pathologists have been able to dissect the brains of some of these players, and have found evidence of CTE.  Also presented are two young men, Owen Thomas, 21-year-old lineman at Penn, who committed suicide by hanging himself in 2010, and 18-year-old Eric Pelly, a high-school athlete who died after suffering a concussion in 2006.  Both young men were shown to have CTE on autopsy.

It is possible that depression and suicide in professional athletes can be due to steroid, alcohol and drug abuse, and the difficulty in adjusting to a new life and employment after a potentially short pro football career. This explanation is difficult to accept for these younger players. It could be possible that there is a link between the brain damage and the ensuing depression, addiction and suicide.

Of course not all football and ice hockey players, wrestlers and boxers wind up depressed or addicted, so CTE is not the only factor. My hunch is that some players are more likely genetically predisposed to encephalopathy, and the repeated minor trauma is the environmental factor which pushes them over the edge.  This could be an explanation for why some teens develop psychosis and others don’t when subject to traumatic brain injury. A meta-analysis from 2011 supported an increased risk of schizophrenia following traumatic brain injury, with a larger effect in those with a genetic predisposition to psychosis.

While more data is needed to show the links between contact sports and CTE, enough evidence is available to encourage more rules and better equipment to protect players from trauma. Children under the age of 16 should not be allowed to play tackle football, as their brains are smaller and still developing, with less protection from TBI. Perhaps pro football careers will have to have limits, such as Steve Young’s self-imposed retirement after he suffered his seventh concussion on a huge hit from Cardinals cornerback Aeneas Williams. As Steve Young says in the documentary “If my knees hurt, we can go deal with it. There is only one place in the body that we don’t understand… the brain is the last frontier.” You only get one brain.

Link to Frontline’s documentary “League of Denial: The NFL’s Concussion Crisis” :

http://www.pbs.org/wgbh/pages/frontline/league-of-denial/

Link to Traumatic Brian injury and schizophrenia

http://www.medscape.com/viewarticle/752208