Monoaminergic modulation of emotional impact in the inferomedial prefrontal cortex.

People assess the impact of emotionally loaded images differently. We define this impact as the average difference between individual ratings of standardized "pleasant" and "unpleasant" images. To determine the neuroanatomical correlate of a hypothetical interaction between emotional impact and cerebral excitability, we first determined the individual effect on cerebral blood flow of a pharmacological challenge with the monoamine reuptake inhibitor clomipramine in nine healthy volunteers. In a later, independent, session the nine volunteers rated pleasant, neutral, and unpleasant images of the standard Empathy Picture System on a scale from +3 to -3. We then used regression analysis to identify sites in the ventromedial prefrontal cortex at which the two separately acquired measures, blood flow change and emotional impact of images, correlated significantly. The regression analysis identified a locus in Brodmann's area 11 of the inferomedial prefrontal cortex (IMPC) at which these two separate measures had significant inverse correlation. Thus, under the specific circumstance of positron emission tomography (PET) of a pharmacological challenge, a key region of the inferomedial prefrontal cortex underwent deactivation in proportion to a separately rated emotional impact of a stimulus. We propose a specific pharmacodynamic mechanism that explains the correlation between the emotional impact and the effect of a serotonin-noradrenaline reuptake inhibitor on cerebral blood flow.