Epigenetic Evidence to Advance Utility of Lifestyle Interventions in Managing Depression in Primary Care Practice




Lee, Jenny
Jaini, Paresh


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PURPOSE: To evaluate and recommend lifestyle interventions as management for depression in primary care practice through systematic review of epigenetic evidence associated with depression. BACKGROUND: Depression is the most common mental health condition in primary care patients in the United States. Compelling evidence shows that maladaptive lifestyle behaviors and environmental conditions are involved in the pathogenesis of depression via disease-promoting epigenetic mechanisms associated with depression in patients. However, lifestyle and environmental factors receive little consideration in current treatment of depression, while pharmacotherapy and psychotherapy are largely utilized. Therefore, considering utility of lifestyle interventions to alter gene expression associated with depression can provide a safe and low-cost option for prevention and treatment of depression. METHODS: We performed a targeted and tailored search of peer-reviewed health science literature in MEDLINE through the PubMed interface. Through systematic review, we selected 34 articles that discussed epigenetic effects of depression as well as lifestyle intervention studies for depression. The search was limited to English language articles published in the last 10 years. RESULTS: Our review consistently indicated that lifestyle modification efforts such as physical activity, anti-inflammatory foods, sleep hygiene, relaxation response, and social connectedness/group support serve as protective and therapeutic modalities for depression. Epigenetic evidence from our review confirmed that adverse lifestyle and environmental stimuli resulted in depression-promoting gene expression. Stress was found to be the most common risk factor for pathogenesis of depression. While few studies showed epigenetic evidence of lifestyle intervention approaches to depression management, relaxation response through meditation showed down-regulation of gene expression associated with stress and trauma that were evident to generally lead to subsequent depressive symptoms. CONCLUSION: Understanding the epigenetic effects of lifestyle and environmental factors on development of depression are of considerable interest for understanding management of depression. While future study of epigenetic effects of multiple lifestyle interventions in depression management is needed, the present study may provide clinically relevant recommendations for using therapeutic lifestyle interventions in patients with depressive disorders in primary care practice, where epigenetic changes may serve as biomarkers for monitoring the course of illness. An epigenetics-based lifestyle intervention approach can aid in prevention and treatment of depression by motivating patients to change risky lifestyle and environmental factors that induce depression-promoting epigenetics.


Research Appreciation Day Award Winner - 2018 Medical Student Government Association - Best in Fourth Year Class