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Brain Stimulation Shows Promise in Curing Bulimia

An encouraging sign for other addictions

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Only 1 in 10 with eating disorders get treatment
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By Shawn Dwyer

11/29/13

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Already used to treat depression and other neurological disorders, repetitive transcranial magnetic stimulation (rTMS) has shown promising signs in treating bulimia and other eating disorders by helping to boost self control.

A study conducted on 20 patients by the department of psychiatry at the University Health Network in Toronto, Canada, found that almost half of the people treated with rTMS spent three to six months without binging and purging, while some remained symptom-free for up to a year. The study’s author, clinical physician Dr. Jonathan Downar, was enthusiastic about the results. “This is among patients who had already tried everything for their eating disorder, and nothing had worked. So, what we're talking about is completely unprecedented.”

The study adds meaningful fuel to previous research linking improvements in addictive behavior to rTMS stimulation. The US National Library of Medicine at the National Institute of Health sums up its own review of earlier research this way: "The results...indicate that rTMS is effective in reducing the level of cravings for smoking, alcohol, and cocaine when applied at high frequencies to the dorsolateral prefrontal cortex (DLPFC). Furthermore, these studies suggest that repeated sessions of high frequency rTMS over the DLPFC may be most effective in reducing the level of smoking and alcohol consumption. Although work in this area is limited, this review indicates that rTMS is a promising modality for treating drug addiction." 

Downar was quick to point out that those who did well with the procedure lacked a connection in their physiological circuitry between “the part of the brain that is supposed to tamp down on urges and cravings and the regulation area.” Conversely, those who did have above-average connections did not respond to treatment. “[Brain stimulation] did nothing for them because a need for more stimulation is not their problem." Downar said.

The so-called “re-tuning” treatment involves the noninvasive use of coils on the scalp that stimulate the brain’s electrical circuits by generating rapid magnetic pulses equivalent in strength to an MRI. It has been used to treat a wide array of neurological disorders, including depression, Parkinson’s disease, and schizophrenia.

Roughly eight million people in North America suffer from some form of chronic eating disorder, and they’re not all women. Sufferers who seek treatment usually receive a combination of psychotherapy, prescription anti-depressants and anti-anxiety medications to help manage excessive preoccupations with food and diet. While this helps with some, not everyone benefits from current treatments. This holds true for the rTMS tests to date on other forms of addictive behavior.

Researchers practically discovered the treatment by accident during a similar case study in 2011 that used rTMS to treat patients suffering from depression. One patient also suffered from bulimia, which, like the depression itself, was surprisingly relieved after two weeks of brain stimulation. Using this as his launching point, Donwar gave his bulimia and anorexia patients 20 rTMS sessions over the course of four to six weeks, resulting in a 50% drop in binging and purging in half of his patients. Another third experienced symptoms reduced by 80%, while some saw their disorder completely disappear.

Despite the promise of repetitive transcranial magnetic stimulation for a majority of patients, a minority of those treated showed no improvement. "Those other 30% to 40% are tough,” said Dr. Doug Klamp, an eating disorder specialist in Scranton, PA. “They can try all the standard antidepressants and antipsychotic medications, and all the behavioral therapy options, but their problem behavior may still go on. For decades.”

Suzanne Mazzeo, a professor of psychology at Virginia Commonwealth University, agreed. “What we currently have for treatment is certainly not working for everyone,” she said. “In addition to ensuring the safety of this new technique and testing it for long-term maintenance, we have to be sure why it works for some and not others, so we can know who would be the most appropriate candidates for it." 

That noted, all the studies to date, however preliminary and diffused among different addictions, would seem to offer potential hope to what might well be a substantial number of addicts. 

Shawn Dwyer is the news editor of  The Fix

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