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Emotional processing and rTMS: does inhibitory theta burst stimulation affect the human startle reflex?

  • Psychiatry and Preclinical Psychiatric Studies - Original Article
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Abstract

Repetitive transcranial magnetic stimulation (rTMS) enables the local and non-invasive modulation of cortical activity and has proved to achieve antidepressant effects. To a lesser extent, rTMS is investigated as a treatment option for anxiety disorders. As the prefrontal cortex and the amygdala represent key components of human emotion regulation, we investigated how prefrontally applied rTMS affects the responsiveness of the subcortical amygdala during a fear-relevant study paradigm to examine potential cortico-limbic effects. Sham-controlled, randomised inhibitory rTMS (continuous theta burst stimulation, TBS) was applied to 102 healthy subjects (female = 54) over the right dorsolateral prefrontal cortex. Subsequently, the emotion-potentiated (unpleasant, neutral, and pleasant International Affective Picture System pictures) acoustic startle response was investigated. Subjective anxiety ratings (anxiety sensitivity, trait and state anxiety) were considered. Picture category affected the startle magnitude as expected for both TBS intervention groups (highest startle response for unpleasant, lowest for pleasant pictures). However, no modulatory effects of TBS on startle potentiation were discerned. No significant interaction effects of TBS intervention, subjective anxiety ratings, and gender were identified. Interestingly, startle habituation was influenced by TBS intervention on a trend-level, with verum TBS leading to an accelerated habituation. We found no evidence for the hypothesis that prefrontal inhibitory TBS affects the responsiveness of the amygdala during the presentation of emotionally relevant stimuli in healthy subjects. Instead, we found accelerated habituation under verum TBS on a statistical trend-level. Hence, some preliminary hints for modulatory effects of inhibitory TBS on basic learning mechanisms could be found.

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Acknowledgments

This work was supported by the fund “Innovative Medical Research” of the University of Muenster Medical School (Project ZW 211105), and the SFB-TRR58, project C02 (Deutsche Forschungsgemeinschaft, DFG). We acknowledge the support by Ann-Christine Robertz and Fred Rist.

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Authors and Affiliations

  1. School of Health, Muenster University of Applied Sciences, Leonardo Campus 8, 48149, Muenster, Germany

    Nadja Vennewald

  2. Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Gebaeude A9, 48149, Muenster, Germany

    Nadja Vennewald, Swantje Notzon, Inga Fohrbeck, Volker Arolt & Peter Zwanzger

  3. Catholic University of Applied Sciences North Rhine-Westphalia, Muenster, Piusallee 89, 48147, Muenster, Germany

    Bernward Winter

  4. Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, University Hospital Klinikum rechts der Isar, Technische Universität München, Langerstr. 3, 81675, Munich, Germany

    Karina Limburg

  5. kbo-Inn-Salzach-Hospital, Gabersee 7, 83512, Wasserburg am Inn, Germany

    Julia Diemer & Peter Zwanzger

  6. Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, 97080, Wuerzburg, Germany

    Katharina Domschke

  7. Department of Psychology, University of Wuerzburg, Marcusstrasse 9-11, 97070, Wuerzburg, Germany

    Paul Pauli

  8. Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nußbaumstraße 7, 80336, Munich, Germany

    Peter Zwanzger

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  1. Nadja Vennewald
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Correspondence to Nadja Vennewald.

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This work was supported by the fund “Innovative Medical Research” of the University of Muenster Medical School (Project ZW 211105), and the SFB-TRR58, project C02 (Deutsche Forschungsgemeinschaft, DFG).

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Vennewald, N., Winter, B., Limburg, K. et al. Emotional processing and rTMS: does inhibitory theta burst stimulation affect the human startle reflex?. J Neural Transm 123, 1121–1131 (2016). https://doi.org/10.1007/s00702-016-1568-8

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