Intermittent Theta Burst Stimulation Increases Reward Responsiveness in Individuals with Higher Hedonic Capacity

Abstract

Background: Repetitive transcranial magnetic stimulation over the left dorsolateral prefrontal cortex (DLPFC) has been documented to influence striatal and orbitofrontal dopaminergic activity implicated in reward processing. However, the exact neuropsychological mechanisms of how DLPFC stimulation may affect the reward system and how trait hedonic capacity may interact with the effects remains to be elucidated.Objective: In this sham-controlled study in healthy individuals, we investigated the effects of a single session of neuronavigated intermittent theta burst stimulation (iTBS) on reward responsiveness, as well as the influence of trait hedonic capacity.Methods: We used a randomized crossover single session iTBS design with an interval of 1 week. We assessed reward responsiveness using a rewarded probabilistic learning task and measured individual trait hedonic capacity (the ability to experience pleasure) with the temporal experience of pleasure scale questionnaire.Results: As expected, the participants developed a response bias toward the most rewarded stimulus (rich stimulus). Reaction time and accuracy for the rich stimulus were respectively shorter and higher as compared to the less rewarded stimulus (lean stimulus). Active or sham stimulation did not seem to influence the outcome. However, when taking into account individual trait hedonic capacity, we found an early significant increase in the response bias only after active iTBS. The higher the individual's trait hedonic capacity, the more the response bias toward the rich stimulus increased after the active stimulation.Conclusion: When taking into account trait hedonic capacity, one active iTBS session over the left DLPFC improved reward responsiveness in healthy male participants with higher hedonic capacity. This suggests that individual differences in hedonic capacity may influence the effects of iTBS on the reward system.

Recovering from depression with repetitive transcranial magnetic stimulation (rTMS): a systematic review and meta-analysis of preclinical studies

“…The effectiveness of rTMS in healthy models compares with human studies involving non-depressed patients and healthy subjects. For example, left human DLPFC stimulation has been demonstrated to reverse hedonic tone dysfunction in addicted subjects 62 , as well as to induce a more pronounced sensitivity to rewarding stimuli in healthy subjects 63,64 . Also, rTMS appeared to selectively reverse depressive-like symptoms while effects on other domains (e.g., anxiety) were rather mixed.…”

Anhedonia across borders: Transdiagnostic relevance of reward dysfunction for noninvasive brain stimulation endophenotypes

“…Duprat and colleagues conducted a crossover study by using an intermittent theta‐burst stimulation (iTBS) protocol in 22 male healthy subjects. All subjects received a single active and sham stimulation over the left DLPFC, with one‐week washout period.…”

Pre-frontal stimulation does not reliably increase reward responsiveness

“…There is also little consensus amongst studies regarding the most effective frontal region to target: the left, bilateral, or right prefrontal cortex ( Chen et al., 2017 ; Li et al., 2014 ). The evidence base also shows considerable variation for the number of treatment sessions provided ( George et al., 2009 ) and the type of TMS protocols administered (e.g., Bakker et al., 2015 ; Chung et al., 2015 ; Duprat et al., 2016b , Duprat et al., 2016a ). Further discrepancies between treatment protocols extend to the frequencies of the rTMS applied, i.e.…”

“…More recent rTMS protocols have begun using intermittent Theta Burst Stimulation (iTBS) to stimulate the left DLPFC ( Duprat et al., 2016b , Duprat et al., 2016a ; Duprat et al., 2017 ). iTBS combines low and high-frequency stimulation and has been shown to be relatively effective in reducing the TMS intensity required to produce a motor evoked response, indicating increased excitability ( Huang et al., 2005 ).…”

“…It has also been associated with neural areas such as the left DLPFC, which have been linked to reward responsiveness using fMRI ( Der-Avakian & Markou, 2012 ; Ott et al., 2011 ) and electrophysiological approaches (e.g., Pizzagalli, et al, 2005 ). More recently the probabilistic learning task has been used to measure reward responsiveness following rTMS stimulation ( Ahn et al., 2013 ; Duprat et al., 2016b , Duprat et al., 2016a ; Duprat et al., 2017 ).…”