TMS for Eating Disorders

About 9% of the US population, or 28.8 million people, will have an eating disorder in their lifetime. Eating disorders include binge eating disorder, anorexia nervosa, and bulimia nervosa. These diseases are associated with high rates of mortality and morbidity and with impaired quality of life.

Although prescription drugs and behavioral therapies can help some, there are still many people who do not respond to these treatments.

Transcranial magnetic stimulation (TMS) is a non-invasive treatment that uses magnetic pulses to change neuron activity in the brain. We will discuss how effective this is and where you can go to get help if you or a loved one have an eating disorder.

Eating Disorders

An eating disorder is a mental health disorder that is characterized by abnormal eating behaviors that negatively affect your physical and/or mental health. Binge eating disorder, anorexia nervosa, and bulimia nervosa are the most common of these disorders.

Binge eating disorder affects 1.4 percent of people during their lifetime, affecting twice as many women as men. Common treatments for it include cognitive-behavioral therapy (CBT) and drug treatments. However, while both have been shown to reduce binge eating, they have a limited effect on weight.

Anorexia is characterized by low weight and an intense fear of gaining weight. If you have anorexia, you will likely restrict food or overexercise to manage your weight. You may also think that you are overweight when you are underweight. A small percentage, 0.6% of people, will develop anorexia in their lifetime and men make up only 5-10% of people it affects.

Bulimia is characterized by excessive binge eating followed by purging. Purging involves vomiting and can include taking laxatives or excessive exercise. Like anorexia, it involves an obsession with your physical appearance. Bulimia affects 1.1% of people in their lifetime and 20% of people suffering from bulimia are men.

About 70% of people with anorexia and 50% of people with bulimia recover within five years. Recovering from binge eating disorder is estimated at 20-60% so the data is less clear.

Only 10% of people with an eating disorder receive treatment and around 80% do not receive proper treatment. These disorders need better access to and more effective treatment.

Signs of an Eating Disorder

If you suspect that you or a loved one has an eating disorder, it is helpful to be able to identify common signs and symptoms so that you can seek help for them or yourself if needed. Symptoms will vary depending on the person and the particular disorder they have. Common symptoms to look out for include:

• Abnormally low or high body weight
• Eating secretly
• Going to the bathroom frequently after a meal
• Irregular diet
• Obsession with weight gain or loss
• Guilt and shame surrounding eating habits
• Obsession with physical appearance
• Stress or discomfort around eating habits

Effects of Eating Disorders

An eating disorder has a wide range of effects both physical and psychological. It has the highest mortality rate of any mental health disorder after opioid overdose with 10,200 directly related deaths per year. This includes death due to starvation of the body and brain and suicide.

Physical Effects

Dehydration and malnutrition can cause kidney failure, seizures, fatigue, constipation, and muscle cramps. Not getting enough nutrients and proteins can lead to decreased immune function and anemia.

Heart problems are particularly likely with anorexia. When the body does not get enough food, it starts to break down its own muscles and other tissues. There is an increased risk of heart failure if muscle from the heart starts to break down or if it does not get enough fuel to pump blood properly.

Impaired brain function and hyperthermia occur when you do not have enough fuel for your brain or body to function properly. The brain uses 20% of the body’s energy, so decreased energy will affect your ability to concentrate as well as affect other brain functions. If you are not getting enough energy for your body to heal itself, you may get hyperthermia.

Digestion problems and teeth and esophagus damage can occur with an eating disorder. This includes nausea and vomiting, blocked intestines, stomach pain, bacterial infections, and blood sugar fluctuations. Throwing up from purging can wear down the enamel on your teeth and damage your esophagus.

Hormone changes can occur as your body uses food to synthesize hormones. Estrogen and testosterone are two hormones that are affected which can cause periods and cause bone loss.

Psychological Effects

• Low self-esteem
• Self-harm
• Obsessiveness
• Anxiety and depression
• Suicidal ideations

People who have an eating disorder are five times more likely to abuse drugs and alcohol. This may be a conscious decision to help with weight loss as some drugs such as alcohol, cocaine, and amphetamines reduce appetite. It may also be used to self-medicate mental health problems so is a particularly high risk for those with co-occurring mental health along with this disorder.

Reasons for Developing an Eating Disorder

The reasons for developing an eating disorder are complex and not entirely clear. There are several factors that are thought to increase your risk of developing one. These can be biological, psychological, and social factors.

Biological Risk Factors

• Family history of an eating disorder – this can be both genetic and due to exposure to unhealthy eating habits
• Family history of mental health conditions
• Type one diabetes – one-quarter of women diagnosed with type one diabetes develop an eating disorder
• History of dieting – weight loss is often encouraged and praised which can make you diet more
• Age – an eating disorder is most common in your teens and early twenties

Psychological Risk Factors

• Low self-esteem
• Anxiety disorders and depression
• Obsessive-compulsive disorder
• Perfectionism particularly when directed at yourself
• Impulsiveness

Social Risk Factors

• Beauty standards – beauty standards tend to put worth on a slim and toned figure
• Bullying – 60% of people with an eating disorder report that bullying affected their development
• Loneliness and isolation
• Trauma including physical and sexual abuse

What is TMS?

TMS is an FDA-approved, non-invasive, and painless medical procedure. A magnetic coil is put on the head of the patient which corresponds to the part of the brain being targeted. This coil is connected to an electric pulse generator. An electrical field is produced which causes an inverted electric current in the brain, activating nearby nerve cells. Using this method you can activate cells that are up to five centimeters into the brain.

The use of electrical pulses to stimulate brain cells started in the early 1900s with the development of electroconvulsive therapy. This was widely used to treat mental illness; however, it was dangerous and painful.

In 1985, the first stable TMS devices were developed and were approved in the US in 2008. TMS to treat an eating disorder was found by accident. It was originally used to treat people with mental health disorders. A patient with co-occurring depression and an eating disorder was treated with TMS in a 2011 case study and the results showed complete relief from both conditions.

Before TMS was used, deep-brain stimulation was used for any eating disorder. This is where electrodes are surgically implanted into the brain area thought to be affected. This method is invasive and holds risks that come with surgery and potentially serious side effects, and it is difficult to adjust or reverse the treatment. TMS is preferred to this method as it stimulated nerve cells without being invasive or carrying the same risks.

What is Repetitive Transcranial Magnetic Stimulation (rTMS)?

Repetitive Transcranial Magnetic Stimulation is where magnetic pulses are induced in multiple sessions, generally over the course of four to five weeks. This typically involves daily treatments for the duration of the treatment. Most TMS programs use this method so rTMS is often used interchangeably with TMS.

Can TMS Help With Overeating?

The brain mechanisms involved in food cravings are thought to be similar to those of drug cravings. Both show increased neural activity in the orbitofrontal and anterior cingulate cortex and decreased regulation from the lateral prefrontal area. TMS typically focuses on increasing the regulation from the lateral prefrontal area.

A 2014 study conducted a one-off session of TMS with women who were strong cravers or had bulimia. The women showed a reduction in craving and binge eating episodes. One potential cause of this is that TMS changes the composition of bacteria in your gut. This can alter your brain’s signals for appetite and tell you that you are full.

Does TMS Cause Weight Gain?

TMS should not cause weight gain. This is a worry which is particularly relevant for those who have co-occurring mental health problems such as depression. There is evidence that antidepressants lead to weight gain for at least six years into treatment. However, TMS can improve both your symptoms of depression and eating disorders without leading to weight gain.

One study suggests that treatment with both antidepressants and TMS could be helpful for severe and enduring anorexia nervosa (SE-AN). This is a particularly difficult case to treat which often co-occurs with depression and for which antidepressants are often prescribed.

A study looks at whether using TMS as well as antidepressants would improve eating disorder symptoms. It showed that eating disorder symptoms were reduced more for those taking antidepressants as well as receiving TMS than for those only receiving TMS.

Does TMS Help With Weight Loss?

At the 2017 annual meeting of the Endocrine Society, Dr. Livio Luzi reported that their study showed TMS to cause weight loss. The study looked at obese patients and found that after five weeks of TMS, food cravings were reduced by 34%. After two months, those who took part in the study had lost about 3.2% of their initial weight compared to 1.8% for those on the placebo.

This is supported by a randomized controlled feasibility trial published in 2018. This study looked at weight change in almost sixty obese patients following four sessions of rTMS to the dorsolateral prefrontal cortex over two weeks or being in a control group. Those who had received the rTMS lost significantly more weight and had a greater reduction in BMI than those who did not. Those in the rTMS group also consumed fewer calories per day than the control group.

While both these studies looked at patients struggling with obesity, they activated the same area of the brain activated when using TMS for eating disorders. Further research would need to confirm that weight loss is found in these cases, however, these studies seem promising.

Related article: TMS Therapy for Parkinsons Disease

Get Help Today

GIA Miami is a mental health clinic that specializes in TMS therapy. We understand that suffering from an eating disorder is complicated and different for everybody and offer advanced and evidence-based treatment tailored to your needs.

We specialize in treating depression, anxiety, and addiction. Therefore, if you have a co-occurring eating disorder with other mental health conditions or an addiction, we may be the perfect place for you.

If you have an eating disorder and you would like to get treatment or more information about your treatment options, please visit our website or contact us today at (833) 713-0828.