Neuromodulation in Psychiatric disorders: Experimental and Clinical evidence for reward and motivation network Deep Brain Stimulation: Focus on the medial forebrain bundle

Deep brain stimulation (DBS) in psychiatric illnesses has been clinically tested over the past 20 years. The clinical application of DBS to the superolateral branch of the medial forebrain bundle in treatment‐resistant depressed patients—one of several targets under investigation—has shown to be promising in a number of uncontrolled open label trials. However, there are remain numerous questions that need to be investigated to understand and optimize the clinical use of DBS in depression, including, for example, the relationship between the symptoms, the biological substrates/projections and the stimulation itself. In the context of precision and customized medicine, the current paper focuses on clinical and experimental research of medial forebrain bundle DBS in depression or in animal models of depression, demonstrating how clinical and scientific progress can work in tandem to test the therapeutic value and investigate the mechanisms of this experimental treatment. As one of the hypotheses is that depression engenders changes in the reward and motivational networks, the review looks at how stimulation of the medial forebrain bundle impacts the dopaminergic system.     

Effects of accumbens DALA microinjections on brain stimulation reward and behavioral activation in intact and 6-OHDA treated rats

The effects of bilateral nucleus accumbens microinjections ofd-ala-met-enkephalinamide (DALA) were assessed in behavioral activation and lateral hypothalamic self-stimulation (LHSS) rate-frequency curve-shift paradigms in normal and accumbens 6-OHDA (4.0 µg) treated rats. Microinjections of DALA (2.5 µg/µl) in the behavioral activation paradigm had little effect on normal activity; however, DALA administered to 6-OHDA treated rats produced a significant overall increase in locomotion. The 6-OHDA DALA-induced locomotion effect peaked at 2 weeks after 6-OHDA treatment and then returned to baseline levels by week 5 posttreatment. Using LHSS, DALA tested over a range of doses (2.5, 5, 10, 20 µg/µl) displayed a weak biphasic reward effect only at the highest dose, which was characterized by an initial suppression followed by an elevation. DALA significantly depressed initial operant motor/performance in LHSS in a dose dependent fashion. Micro-injections of the normally ineffective low dose of DALA (2.5 µg/µl) following accumbens 6-OHDA treatment produced a significant LHSS reward decrease 2 weeks posttreatment, while LHSS motor/performance was relatively unaffected. Results are discussed in terms of opiate-dopamine and limbic-motor interactions.     

Differences in bioavailability between cocaine and cocaethylene and their implications for drug-reward studies

Cocaethylene, a psychoactive metabolite resulting from combined ethanol/cocaine consumption, is of interest because its psychostimulant properties may partially underlie combined cocaine/ethanol use, and because it has the potential for use as a probe of drug reward mechanisms due to its enhanced selectivity at monoamine uptake sites compared to cocaine. To determine the relative systemic bioavailabilities of cocaine and cocaethylene, sequential plasma samples were obtained from awake rats following drug administration. Following intravenous administration of 3 µmol/kg (molar equivalent of 1 mg/kg cocaine-HCl), both drugs achieved similar time courses and areas under the plasma concentration versus time curve. In contrast, intraperitoneal administration of 44 µmol/kg (molar equivalent of 15 mg/kg cocaine HCl) showed peak plasma levels, and the area under the plasma concentration vs time curve for cocaine to be approximately twice that for cocaethylene. Comparison of dose corrected areas under the curve of the two routes of administration for each drug indicated that relative systemic bioavailability of cocaethylene following intraperitoneal administration is only 58% that of cocaine. In addition, the elimination of both cocaine and cocaethylene was found to be slower following intraperitoneal administration compared to the intravenous route. The implications of these results are discussed with respect to the relative potency of these two compounds, as inferred from behavioral, drug reward, and lethality studies. Also, the differences noted will need to be taken into account when making mechanistic interpretations from comparative drug reward studies.     

Injections of -amphetamine into the ventral pallidum increase locomotor activity and responding for conditioned reward: a comparison with injections into the nucleus accumbens

The nucleus accumbens and ventral pallidum receive dopamine (DA) projections from the mesencephalon. Although DA inputs to the nucleus accumbens are implicated in both locomotion and reward processes, little is known of the behavioural significance of DA in the ventral pallidum. These studies examined the effects of -amphetamine injected into the nucleus accumbens or ventral pallidum on locomotor activity and responding for a conditioned reward (CR). In the nucleus accumbens -amphetamine dose dependently (1, 3 and 10 μg) increased locomotion within 5–10 min of injection. Intra-ventral pallidum microinjections of -amphetamine also increased activity in this dose range, but the effect occurred with a longer latency (5–20 min). The magnitude of the response evoked by ventral pallidum injections was lower than that evoked by nucleus accumbens injections. The GABA_A antagonist picrotoxin (0.1 μg) stimulated activity when injected into the ventral pallidum but not the nucleus accumbens, providing a pharmacological dissociation between the two injection sites. In the CR studies, -amphetamine injected into both sites potentiated responding for a CR previously paired with food delivery, without altering responding on an inactive lever. Picrotoxin injected into the ventral pallidum reduced responding and abolished the selectivity of responding for CR. The results show that DA release in the ventral pallidum enhances locomotion and responding for a CR, providing evidence that DA in the ventral pallidum plays a significant role in the mediation of the effects of -amphetamine. The failure of picrotoxin to elevate responding for CR despite increasing locomotor activity indicates that pharmacologically-induced blockade of GABA_A receptors in the ventral pallidum disrupts goal-directed responding.     

Response involvement in brain stimulation reward

The hypothesis that responding contributes to the reward value of brain stimulation was tested in two novel experimental paradigms. In the first experiment rats lever-presssed for rewarding brain stimulation during 90 sec periods. After each period the lever automatically retracted and experimenter-administered stimulation (EAS) was presented at the same rate and current parameters as during the self-stimulation (SS). The rats could demonstrate a preference for SS (vs EAS) by pressing a reset lever on the opposite wall of the test chamber. This action terminated the EAS and reinstated the SS-lever for an additional 90 sec. Results showed that the rats preferred to respond for stimulation than to have that same stimulation administered by the experimenter. This was true even when a signal preceded each train of EAS or when subjects had a great deal of previous EAS experience. In the second experiment conditioned taste preferences were observed following novel taste/SS pairings but not following novel taste/EAS pairings. The data from these two experiments suggest that responding contributes to the rewarding value of brain stimulation.     

Breeding for 50-kHz Positive Affective Vocalization in Rats

Adolescent and adult rats exhibit at least two distinct ultrasonic vocalizations that reflect distinct emotional states. Rats exhibit 22-kHz calls during social defeat, drug withdrawal, as well as in anticipation of aversive events. In contrast, 50-kHz calls are exhibited in high rates during play behavior, mating, as well as in anticipation of rewarding events. The neurochemistry of 22-kHz and 50-kHz calls closely matches that of negative and positive emotional systems in humans, respectively. The aim of this study was to replicate and further evaluate selective breeding for 50-kHz vocalization, in preparation for the analysis of the genetic underpinnings of the 50-kHz ultrasonic vocalization (USV). Isolate housed adolescent rats (23–26 days old) received experimenter administered tactile stimulation (dubbed tickling), which mimicked the rat rough-and-tumble play behavior. This stimulation has previously been shown to elicit high levels of 50-kHz USVs and to be highly rewarding in isolate-housed animals. Each tickling session consisted of 4 cycles of 15 seconds stimulation followed by 15 seconds no stimulation for a total of 2 min, and was repeated once per day across 4 successive days. Rats were then selected for either High or Low levels of sonographically verified 50-kHz USVs in response to the stimulation, and a randomly selected line served as a control (Random group). Animals emitted both 22-kHz and 50-kHz types of calls. After 5 generations, animals in the High Line exhibited significantly more 50-kHz and fewer 22-kHz USVs than animals in the Low Line. Animals selected for low levels of 50-kHz calls showed marginally more 22-kHz USVs then randomly selected animals but did not differ in the rate of 50-kHz calls. These results extend our previous findings that laboratory rats could be bred for differential rates of sonographically verified 50-kHz USVs.     

Sucrose sham feeding decreases accumbens norepinephrine in the rat

Noradrenergic projections from the dorsomedial medulla reach the shell of the nucleus accumbens (NAcc), a structure implicated in both reward and feeding behavior. Despite this relationship, the effect of food reward on accumbens norepinephrine (NE) remains uninvestigated. In the course of assessing dopamine (DA) in the NAcc during sucrose ingestion [0.03, 0.1, and 0.3 M; Am. J. Physiol., Regul. Integr. Comp. Physiol., 286 (2004) R31], we also analyzed NE in the microdialysis samples from 14 ad-libitum-fed male rats. In contrast to DA, which increased with sucrose concentration (+20-47%) during sham feeding, in the same animals, NE levels were reduced (approximately -20%), regardless of sucrose concentration. These results demonstrate a novel relationship between accumbens DA and NE during orosensory stimulation with a preferred nutrient.     

Behavioral effects of stimulating positive reward sites in the central tegmentum of rhesus monkeys.

Rhesus monkeys with electrodes chronically implanted in reward sites in central tegmentum were given telemetered brain stimulation while they were free ranging alone or with cagemates. Stimulation seemed to induce a relaxed positive affect as measured by increased huddling, increased lipsmacking, reduced muscle tone, increased solicitation of grooming and increased grooming of other monkeys. Stimulation did not increase dominant/submissive interactions and seemed to have no effect on aggression or fear. These results are very different from those obtained from an anterolateral hypothalamic self-stimulation site and indicate that fibers which provide input from this area to anterolateral hypothalamus are not solely responsible for effects obtained in the anterolateral hypothalamic area.     

Self-deprivation: a test of the reward hypothesis

Self-deprivation refers to the observation that despite severe levels of water and food deprivation some rats dramatically reduce food and water intake when brain stimulation reward and the alternative reward are placed in competition. In order to determine if the rewarding properties of brain stimulation are responsible for self-deprivation, rats were implanted bilaterally with stimulating electrodes and subsequently tested for self-deprivation and preferences among various electrode locus/stimulation current combinations. According to the reward hypothesis, the relative degree of self-deprivation observed for each electrode/current pair should predict the order of preference for each combination when different electrode/current pairs are placed in competition. Likewise, across all combinations of electrodes and intensities, increasing preferences should be associated with increasing self-deprivation. The findings of the study provide support for the reward hypothesis of self-deprivation. The correlation between the self-deprivation and the preference measure was r = 0.62 (p less than 0.001), which rose to r = 0.80 (p less than 0.001) when floor and ceiling effects were taken into account. It was concluded that the rewarding aspects of brain stimulation are responsible for the self-deprivation phenomenon.     

Electrophysiological measures of conflict and reward processing are associated with decisions to engage in physical effort

Anterior cingulate cortex (ACC), a key brain region involved in cognitive control and decision making, is suggested to mediate effort- and value-based decision making, but the specific role of ACC in this process remains debated. Here we used frontal midline theta (FMT) and the reward positivity (RewP) to examine ACC function in a value-based decision making task requiring physical effort. We investigated whether (1) FMT power is sensitive to the difficulty of the decision or to selecting effortful actions, and (2) RewP is sensitive to the subjective value of reward outcomes as a function of effort investment. On each trial, participants chose to execute a low-effort or a high-effort behavior (that required squeezing a hand-dynamometer) to obtain smaller or larger rewards, respectively, while their brainwaves were recorded. We replicated prior findings that tonic FMT increased over the course of the hour-long task, which suggests increased application of control in the face of growing fatigue. RewP amplitude also increased following execution of high-effort compared to low-effort behavior, consistent with increased valuation of reward outcomes by ACC. Although neither phasic nor tonic FMT were associated with decision difficulty or effort selection per se, an exploratory analysis revealed that the interaction of phasic FMT and expected value of choice predicted effort choice. This interaction suggests that phasic FMT increases specifically under situations of decision difficulty when participants ultimately select a high-effort choice. These results point to a unique role for ACC in motivating and persisting at effortful behavior when decision conflict is high.