Stephan Taylor, MD
“Neuromodulation is really about translating what we know about the brain to help us find better treatments.”
The intriguing relationship between the concepts of the brain and mind, along with a desire to help others through medicine, drew Stephan Taylor into his current pursuits as a research psychiatrist. Taylor has developed a complex and varied portfolio of research and clinical work across a range of brain illnesses, including schizophrenia, obsessive compulsive disorder, and depression.
“Part of my interest in being able to look at a broad spectrum of mental health disorders is because each affects the brain differently, and how they affect a person varies depending on each individual’s situation,” he says.
Taylor’s research investigations include the use of brain imaging to better understand how the brain’s circuitry operates and how those interworkings are affected by illness. “If we can understand what is going on in a person’s brain, how depression or another condition is produced by a brain abnormality, it can be helpful for people to understand the nature their psychiatric illness – that it is something that is going on in their brain and not their fault.”
Taylor applies information gathered from neuroimaging to help refine various brain stimulation techniques (also called neuromodulation) that can be used to alter brain function with the goal of improving symptoms of depression and related illnesses. “Neuroimaging allows us to look at how the brain is altered in, say, depression, and then take that information and use it to inform where we can stimulate the brain. Imaging techniques allow us to tailor the treatment to the individual, and to validate the effects of that treatment,” he says.
Repetitive transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT) are two neuromodulation techniques that are used to treat people with depression and other brain illnesses. In TMS therapy, the brain is stimulated using electromagnetic fields, completely non-invasively. ECT therapy, which has been used for decades to treat patients with severe depression, involves applying a brief electrical pulse to the scalp while the patient is under anesthesia. Both procedures are extremely safe and have been found to relieve depression symptoms in people who do not respond to more common forms of treatment, or who are unable or unwilling to tolerate the side effects associated with medications.
For the future of advances in the field of depression research and treatment, Taylor sees genetics and neuroscience providing the greatest gains. “I think we will begin to see different studies combining genetics and electrical brain activity with behavior research to help identify subtypes of depression that will respond to treatment. Neuroscience, which is still in its formative stages, will expand rapidly and continue to grow so that when we have a patient come in who has all or most of the symptoms of depression, they will get a more specific label instead of the broad labels we have to use now,” Taylor says. “We need to be able to distinguish better labels and corresponding treatments, to learn to combine treatments to benefit the patient and use them to treat the patient based on specific information about their genetics and the type of depression they have.”
“In the future genetics might demonstrate how to use ‘risk genes’ in ways that could help prescribe treatment. But we also need to learn how to handle the knowledge of risks, and be sensitive to how people respond to hearing that they are a risk for a certain condition,” he says. “All depressions are different, so we need different treatments to benefit individual patients.”
Taylor finds continued motivation in the intellectual excitement of new discoveries, as well as being able to help patients on an individual level. “I think on a broader, more philosophical scale, understanding the mind-brain connection is one of the major frontiers of science, and the sorts of things we are doing in psychiatry are connected with many different areas of human experience, like identity, values, and choice,” he says.
“We often see patients’ depressions sustained because their life circumstances are not good, so we get into areas of the mind that are really fascinating, like what motivates a person to get up and work, why people find reward in doing certain things, and how the social structure reinforces a person’s ability to do things, or, alternatively, how it suppresses or limits what they want to do. Those are all things we touch upon in psychiatry, and to me, that is exciting.”