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Modulating Emotion Perception: Opposing Effects of Inhibitory and Excitatory Prefrontal Cortex Stimulation

  • Author Footnotes
    2 SN and CS contributed equally to this work and should be considered as joint first authors. PZ and MJ contributed equally to this work and should be considered as joint senior authors.
    Swantje Notzon
    Footnotes
    2 SN and CS contributed equally to this work and should be considered as joint first authors. PZ and MJ contributed equally to this work and should be considered as joint senior authors.
    Affiliations
    Department of Psychiatry and Psychotherapy, University Hospital Muenster, Muenster, Germany
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  • Author Footnotes
    2 SN and CS contributed equally to this work and should be considered as joint first authors. PZ and MJ contributed equally to this work and should be considered as joint senior authors.
    Christian Steinberg
    Footnotes
    2 SN and CS contributed equally to this work and should be considered as joint first authors. PZ and MJ contributed equally to this work and should be considered as joint senior authors.
    Affiliations
    Institute for Biomagnetism and Biosignal Analysis and Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
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  • Author Footnotes
    2 SN and CS contributed equally to this work and should be considered as joint first authors. PZ and MJ contributed equally to this work and should be considered as joint senior authors.
    Peter Zwanzger
    Footnotes
    2 SN and CS contributed equally to this work and should be considered as joint first authors. PZ and MJ contributed equally to this work and should be considered as joint senior authors.
    Affiliations
    Department of Psychiatry and Psychotherapy, University Hospital Muenster, Muenster, Germany

    kbo-Inn-Salzach-Hospital, Wasserburg am Inn, Germany

    Ludwig Maximilian University, Munich, Germany
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  • Author Footnotes
    2 SN and CS contributed equally to this work and should be considered as joint first authors. PZ and MJ contributed equally to this work and should be considered as joint senior authors.
    Markus Junghöfer
    Correspondence
    Address correspondence to Markus Junghöfer, Ph.D., Institute for Biomagnetism and Biosignal Analysis, University of Muenster, D-48149 Germany.
    Footnotes
    2 SN and CS contributed equally to this work and should be considered as joint first authors. PZ and MJ contributed equally to this work and should be considered as joint senior authors.
    Affiliations
    Institute for Biomagnetism and Biosignal Analysis and Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
    Search for articles by this author
  • Author Footnotes
    2 SN and CS contributed equally to this work and should be considered as joint first authors. PZ and MJ contributed equally to this work and should be considered as joint senior authors.
Published:December 29, 2017DOI:https://doi.org/10.1016/j.bpsc.2017.12.007

      Abstract

      Background

      Excitatory repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (dlPFC) is approved by the U.S. Food and Drug Administration for the treatment of adult patients with treatment-resistant major depressive disorder (MDD). This stimulation is supposed to restore excitability of prefrontal cortex regions that exhibit diminished regulation of emotion-generative systems in MDD. Based on the valence lateralization hypothesis, inhibitory rTMS of the right dlPFC has also been applied in MDD. This approach has proved to be effective, although meta-analyses of emotional perception and affective regulation in healthy control subjects and patients with depression do not support functional asymmetries within dlPFC regions.

      Methods

      To shed more light on this discrepancy, the effects of excitatory and inhibitory rTMS of the right dlPFC on visual emotional perception were compared in two groups of 41 healthy participants overall. Before and after rTMS stimulation, participants viewed fearful and neutral faces while whole-head magnetoencephalography was recorded and supplemented by behavioral tests.

      Results

      Visual sensory processing of fearful facial expressions, relative to neutral facial expressions, was reduced after excitatory stimulation and was increased after inhibitory stimulation within right occipital and right temporal regions. Correspondingly, after excitatory rTMS compared with inhibitory rTMS, participants displayed relatively reduced reaction times in an emotion discrimination task and showed reduced emotional arousal.

      Conclusions

      These results support the hypothesis that excitatory rTMS compared with inhibitory rTMS of the right dlPFC strengthens top-down control of aversive stimuli in healthy control subjects, which should encourage more research on mechanisms of excitatory/inhibitory dlPFC-rTMS protocols in general and on neuromodulatory treatment of MDD.

      Keywords

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      Linked Article

      • Testing Causal Relationships Between Emotion Processing Circuitry and Behavior Using Noninvasive Brain Stimulation
        Biological Psychiatry: Cognitive Neuroscience and NeuroimagingVol. 3Issue 4
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          Two systems interact to facilitate attention to and regulation of emotional stimuli: a stimulus-driven system associated with limbic regions, particularly the amygdala, that is involved in the rapid deployment of attentional resources to potential threatening/emotionally salient information in the environment, and a frontal-cingulo-parietal domain-general cognitive control system. These two systems are thought to interact during the processing of emotional stimuli and the regulation of one’s own emotional state, predominantly via top-down regulation of the stimulus-driven limbic system, mediated by the dorsolateral prefrontal cortex (DLPFC) (1).
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