Repetitive Transcranial Magnetic Stimulation in Bulimia Nervosa: Preliminary Results of a Single-Centre, Randomised, Double-Blind, Sham-Controlled Trial in Female Outpatients

Abstract

Background: Bulimia nervosa (BN) is often associated with depressive symptoms and treatment with antidepressants has shown positive effects. A shared deficient serotonergic transmission was postulated for both syndromes. The left dorsolateral prefrontal cortex was argued to regulate eating behaviour and to be dysfunctional in eating disorders. Methods: Fourteen women meeting DSM-IV criteria for BN were included in a randomised placebo-controlled double-blind trial. In order to exclude patients highly responsive to placebo, all patients were first submitted to a one-week sham treatment. Randomisation was followed by 3 weeks of active treatment or sham stimulation. As the main outcome criterion we defined the change in binges and purges. Secondary outcome variables were the decrease of the Hamilton Depression Rating Scale (HDRS), the Beck Depression Inventory (BDI) and the Yale-Brown Obsessive Compulsive Scale (YBOCS) over time. Results: The average number of binges per day declined significantly between baseline and the end of treatment in the two groups. There was no significant difference between sham and active stimulation in terms of purge behaviour, BDI, HDRS and YBOCS over time. Conclusion: These preliminary results indicate that repetitive transcranial magnetic stimulation (rTMS) in the treatment of BN does not exert additional benefit over placebo. A larger number of patients might clarify a further role of rTMS in the treatment of BN.

Repetitive Transcranial Magnetic Stimulation Reduces Cue-Induced Food Craving in Bulimic Disorders

“…One 3-week sham-controlled, randomized, double-blind trial (14) studied the effects of five rTMS sessions per week in patients with BN. Bingeing, vomiting, and self-rated depressive and obsessive-compulsive symptoms improved in both groups but with no group by time interaction on any of the measures.…”

“…In healthy women with high levels of food craving, rTMS to DLPFC prevented an increase in food craving following cue exposure to food (13). One previous rTMS trial in BN did not detect differences between real and sham rTMS effects on bulimic and mood symptoms (14).…”

Inpatient versus Day Clinic Treatment for Bulimia Nervosa: A Randomized Trial

“…For severe bulimia nervosa, pharmacological treatment is also recommended to influence binge eating as well as depression, which both might be related to a shared deficit in serotonergic transmission [16]. Therefore, we thought it unethical to refuse additional medication if necessary (fluoxetin, 60 mg).…”

Neuroimaging and neuromodulation approaches to study eating behavior and prevent and treat eating disorders and obesity

“…Several case reports (Kamolz et al, 2008; McClelland et al, 2013b) and an open-label study (Van den Eynde et al, 2013) (not included in the table) suggest potential for rTMS in anorexia nervosa, but findings should be replicated in placebo-controlled trials. For the case of B N, an early case report suggested potential benefits with rTMS (Hausmann et al, 2004), but this was not confirmed in a subsequent clinical trial that used this technique over 3 weeks (Walpoth et al, 2008). A recent case study reported beneficial effects using 10 Hz rTMS applied over a different target, the dorsomedial prefrontal cortex, in a refractory patient with BN (20 sessions, 4 weeks) (Downar et al, 2012).…”