Effort-based decision-making in major depressive disorder: a translational model of motivational anhedonia

Effort-related motivational effects of the VMAT-2 inhibitor tetrabenazine: implications for animal models of the motivational symptoms of depression

Motivated behaviors are often characterized by a high degree of behavioral activation, and work output and organisms frequently make effort-related decisions based upon cost/benefit analyses. Moreover, people with major depression and other disorders often show effort-related motivational symptoms such as anergia, psychomotor retardation, and fatigue. It has been suggested that tasks measuring effort-related choice behavior could be used as animal models of the motivational symptoms of depression, and the present studies characterized the effort-related effects of the vesicular monoamine transport (VMAT) inhibitor tetrabenazine. Tetrabenazine produces depressive symptoms in humans and, because of its selective inhibition of VMAT-2, it preferentially depletes dopamine (DA). Rats were assessed using a concurrent fixed-ratio 5/chow feeding choice task that is known to be sensitive to dopaminergic manipulations. Tetrabenazine shifted response choice in rats, producing a dose-related decrease in lever pressing and a concomitant increase in chow intake. However, it did not alter food intake or preference in parallel free-feeding choice studies. The effects of tetrabenazine on effort-related choice were reversed by the adenosine A2A antagonist MSX-3 and the antidepressant bupropion. A behaviorally active dose of tetrabenazine decreased extracellular DA in nucleus accumbens and increased expression of DARPP-32 in accumbens medium spiny neurons in a pattern indicative of reduced transmission at both D1 and D2 DA receptors. These experiments demonstrate that tetrabenazine, which is used in animal models to produce depression-like effects, can alter effort-related choice behavior. These studies have implications for the development of animal models of the motivational symptoms of depression and related disorders.

The neuroimmune basis of fatigue

The exact nature and pathophysiology of fatigue remain largely elusive despite its high prevalence in physically ill patients. Studies on the relationship between the immune system and the central nervous system provide a new perspective on the mechanisms of fatigue. Inflammatory mediators that are released by activated innate immune cells at the periphery and in the central nervous system alter the metabolism and activity of neurotransmitters, generate neurotoxic compounds, decrease neurotrophic factors, and profoundly disturb the neuronal environment. The resulting alterations in fronto-striatal networks together with the activation of insula by inflammatory interoceptive stimuli underlie the many dimensions of fatigue including reduced incentive motivation, decreased behavioral flexibility, uncertainty about usefulness of actions, and awareness of fatigue.

Measuring reinforcement learning and motivation constructs in experimental animals: relevance to the negative symptoms of schizophrenia

The present review article summarizes and expands upon the discussions that were initiated during a meeting of the Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia (CNTRICS; http://cntrics.ucdavis.edu) meeting. A major goal of the CNTRICS meeting was to identify experimental procedures and measures that can be used in laboratory animals to assess psychological constructs that are related to the psychopathology of schizophrenia. The issues discussed in this review reflect the deliberations of the Motivation Working Group of the CNTRICS meeting, which included most of the authors of this article as well as additional participants. After receiving task nominations from the general research community, this working group was asked to identify experimental procedures in laboratory animals that can assess aspects of reinforcement learning and motivation that may be relevant for research on the negative symptoms of schizophrenia, as well as other disorders characterized by deficits in reinforcement learning and motivation. The tasks described here that assess reinforcement learning are the Autoshaping Task, Probabilistic Reward Learning Tasks, and the Response Bias Probabilistic Reward Task. The tasks described here that assess motivation are Outcome Devaluation and Contingency Degradation Tasks and Effort-Based Tasks. In addition to describing such methods and procedures, the present article provides a working vocabulary for research and theory in this field, as well as an industry perspective about how such tasks may be used in drug discovery. It is hoped that this review can aid investigators who are conducting research in this complex area, promote translational studies by highlighting shared research goals and fostering a common vocabulary across basic and clinical fields, and facilitate the development of medications for the treatment of symptoms mediated by reinforcement learning and motivational deficits.

Parabolic discounting of monetary rewards by physical effort

When humans and other animals make decisions in their natural environments prospective rewards have to be weighed against costs. It is well established that increasing costs lead to devaluation or discounting of reward. While our knowledge about discount functions for time and probability costs is quite advanced, little is known about how physical effort discounts reward. In the present study we compared three different models in a binary choice task in which human participants had to squeeze a handgrip to earn monetary rewards: a linear, a hyperbolic, and a parabolic model. On the group as well as the individual level, the concave parabolic model explained most variance of the choice data, thus contrasting with the typical hyperbolic discounting of reward value by delay. Research on effort discounting is not only important to basic science but also holds the potential to quantify aberrant motivational states in neuropsychiatric disorders.

Neural substrates underlying effort computation in schizophrenia

The lack of initiative, drive or effort in patients with schizophrenia is linked to marked functional impairments. However, our assessment of effort and motivation is crude, relying on clinical rating scales based largely on patient recall. In order to better understand the neurobiology of effort in schizophrenia, we need more rigorous measurements of this construct. In the behavioural neuroscience literature, decades of work has been carried out developing various paradigms to examine the neural underpinnings of an animal's willingness to expend effort for a reward. Here, we shall review this literature on the nature of paradigms used in rodents to assess effort, as well as those used in humans. Next, the neurobiology of these effort-based decisions will be discussed. We shall then review what is known about effort in schizophrenia, and what might be inferred from experiments done in other human populations. Lastly, we shall discuss future directions of research that may assist in shedding light on the neurobiology of effort cost computations in schizophrenia.

Negative symptoms of schizophrenia are associated with abnormal effort-cost computations

BACKGROUND

Decision-making studies show that response selection is influenced by the "effort cost" associated with response alternatives. These effort-cost calculations seem to be mediated by a distributed neural circuit including the anterior cingulate cortex and subcortical targets of dopamine neurons. On the basis of evidence of dysfunction in these systems in schizophrenia (SZ), we examined whether effort-cost computations were impaired in SZ patients and whether these deficits were associated with negative symptoms.

METHODS

Effort-cost decision-making performance was evaluated in 44 patients with SZ and 36 demographically matched control subjects. Subjects performed a computerized task where they were presented with a series of 30 trials in which they could choose between making 20 button presses for $1 or 100 button presses for higher amounts (varying from $3 to $7 across trials). Probability of reward receipt was also manipulated to determine whether certain (100%) or uncertain (50%) reward affected effort-based decision-making.

RESULTS

Patients were less likely than control subjects to select the high-effort response alternative during the 100% probability condition, particularly when the value payoff was highest (i.e., $6 and $7). Patients were also less likely to select the high-effort option on trials after reward in the 50% probability condition. Furthermore, these impairments in effort-cost computations were greatest among patients with elevated negative symptoms. There was no association with haloperidol equivalent dosage.

CONCLUSIONS

The motivational impairments of SZ might be associated with abnormalities in estimating the "cost" of effortful behavior. This increased effort cost might undermine volition.

Parsing Anhedonia: Translational Models of Reward-Processing Deficits in Psychopathology

The term anhedonia has long been used in the psychiatric literature to describe reward-processing dysfunction in psychopathology, especially depression and schizophrenia. Although anhedonia literally describes a lack of pleasurable experiences in everyday life, recent advances in both the basic science and clinical literatures indicate that reward deficits in these disorders are much broader than hedonic responses. In this article, we summarize some of the recent theoretical and empirical advances in understanding deficits in reward processing and their neurobehavioral mechanisms, with a particular focus on the neural underpinnings of motivation and effort-based decision making. We also highlight the potential of translational neuroscience to enhance diagnostic clarity by defining clinical symptoms in terms of underlying pathophysiology.

Hot and cold cognition in depression

We discuss the importance of cognitive abnormalities in unipolar depression, drawing the distinction between "hot" (emotion-laden) and "cold" (emotion-independent) cognition. "Cold" cognitive impairments are present reliably in unipolar depression, underscored by their presence in the diagnostic criteria for major depressive episodes. There is good evidence that some "cold" cognitive abnormalities do not disappear completely upon remission, and that they predict poor response to antidepressant drug treatment. However, in many studies the degree of impairment is moderately related to symptoms. We suggest that "cold" cognitive deficits in unipolar depression may in part be explicable in terms of alterations in "hot" processing, particularly on tasks that utilize feedback, on which depressed patients have been reported to exhibit a "catastrophic response to perceived failure." Other abnormalities in "hot" cognition are commonly observed on tasks utilizing emotionally valenced stimuli, with numerous studies reporting mood-congruent processing biases in depression across a range of cognitive domains. Additionally, an emerging literature indicates reliable reward and punishment processing abnormalities in depression, which are especially relevant for hard-to-treat symptoms such as anhedonia. Both emotional and reward biases are strongly influenced by manipulations of the neurochemical systems targeted by antidepressant drugs. Such a pattern of "hot" and "cold" cognitive abnormalities is consistent with our cognitive neuropsychological model of depression, which proposes central roles for cognitive abnormalities in the generation, maintenance, and treatment of depressive symptoms. Future work should examine in greater detail the role that "hot" and "cold" cognitive processes play in mediating symptomatic improvement following pharmacological, psychological, and novel brain circuit-level interventions.

Nucleus accumbens neurotransmission and effort-related choice behavior in food motivation: effects of drugs acting on dopamine, adenosine, and muscarinic acetylcholine receptors

Mesolimbic dopamine (DA) is a critical component of the brain circuitry regulating behavioral activation and effort-related processes. Although nucleus accumbens (NAc) DA depletions or antagonism leave aspects of appetite and primary food motivation intact, rats with impaired DA transmission reallocate their instrumental behavior away from food-reinforced tasks with high response requirements, and instead select less effortful food-seeking behaviors. Previous work showed that adenosine A2A antagonists can reverse the effects of DA D2 antagonists on effort-related choice, and that stimulation of adenosine A2A receptors produces behavioral effects that are similar to those induced by DA antagonism. The present review summarizes the literature on the role of NAc DA and adenosine in effort-related processes, and also presents original data on the effects of local stimulation of muscarinic acetylcholine receptors in NAc core. Local injections of the muscarinic agonist pilocarpine directly into NAc core produces shifts in effort-related choice behavior similar to those induced by DA antagonism or A2A receptor stimulation, decreasing lever pressing but increasing chow intake in rats responding on a concurrent fixed ratio/chow feeding choice task. In contrast, injections into a neostriatal control site dorsal to the NAc were ineffective. The actions of pilocarpine on this task were attenuated by co-administration of the muscarinic antagonist scopolamine. Thus, drugs that act on DA, adenosine A2A, and muscarinic receptors regulate effort-related choice behavior, which may have implications for the treatment of psychiatric symptoms such as psychomotor slowing, fatigue or anergia that can be observed in depression and other disorders.

Paradoxical dopaminergic drug effects in extraversion: dose- and time-dependent effects of sulpiride on EEG theta activity

Dopaminergic drugs frequently produce paradoxical effects depending on baseline performance levels, genotype, or personality traits. The present study for the first time aimed to specify the mechanisms underlying such opposite effects using the following recently reported scenario as an example: depending on the personality trait agentic extraversion (agentic facet, aE; i.e., assertiveness, dominance, ambition, positive emotionality) the selective dopamine D2 receptor antagonist sulpiride (200 mg) had opposite effects on resting posterior vs. anterior theta activity in the electroencephalogram (EEG). In order to better describe these opposite pharmaco-EEG effects and to generate hypotheses regarding the underlying mechanisms, we measured the EEG intermittently over 5 h in 80 healthy male volunteers extremely high or low in aE who had received either placebo or one of three doses of sulpiride (50, 200, or 400 mg). The findings suggest a model postulating stronger pre- vs. postsynaptic subreceptor effects in high aE individuals compared to low aE individuals. Future studies may now systematically apply the model to other examples of paradoxical dopaminergic drug effects and examine the molecular basis of individual differences in pre- vs. postsynaptic dopamine D2 subreceptor sensitivities and densities.