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Low levels of brain stimulation with electrodes may temporarily lessen bulimia symptoms

Transcranial direct current stimulation of prefrontal cortex temporarily effective in proof-of-principle trial


A 20-minute session of transcranial direct current stimulation transiently improves the symptoms of bulimia nervosa sufferers, according to a study published January 25, 2017, in the open-access journal PLOS ONE by Maria Kekic from King's College London, UK, and colleagues.

Bulimia nervosa is a mental health condition and is linked with changes in the dorsolateral prefrontal cortex, which is involved with reward processing and self-regulatory control. While cognitive behavioral therapy is the gold standard for bulimia treatment, as many as half of all bulimia patients who undergo it will still relapse into their eating disorders.

The authors of the present study conducted a small proof-of-principle study of brain stimulation, carrying out a double-blind, randomized, controlled trial of 39 bulimic adults (2 males and 37 females). They used electrodes in different configurations to carry out low-amplitude, direct current, transcranial stimulation of the participants' dorsolateral prefrontal cortex in three 20-minute sessions, including one sham session where the electrodes where the stimulation lasted only 30 seconds. Participants then self-reported their desire to binge eat, fear of weight gain, general mood, and frequency of bulimic behaviors in the 24 hours following treatment.

The researchers found that the treatment compared to the sham was effective in lessening bulimia symptoms, at least immediately following the study. It also appeared that the optimal orientation of the electrodes was to have the anode on the right and the cathode on the left side of participants' heads.

The study did not exclude individuals with co-occurring mental disorders and the outcomes were self-reported. Nonetheless, the authors state that this is the first investigation of transcranial direct current stimulation for bulimia. Future multi-session trials could examine how long the effects lasted, and help determine the treatment's potential as a therapy for bulimia nervosa.

Maria Kekic says: "Although these are modest, early findings, there is a clear improvement in symptoms and decision-making abilities following just one session of tDCS. With a larger sample and multiple sessions of treatment over a longer period of time, it is likely that the effects would be even stronger. This is something we're now looking to explore in future studies."


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Citation: Kekic M, McClelland J, Bartholdy S, Boysen E, Musiat P, Dalton B, et al. (2017) Single-Session Transcranial Direct Current Stimulation Temporarily Improves Symptoms, Mood, and Self-Regulatory Control in Bulimia Nervosa: A Randomised Controlled Trial. PLoS ONE 12(1): e0167606. doi:10.1371/journal.pone.0167606

Funding: This research was funded by a Medical Research Council/Institute of Psychiatry, Psychology & Neuroscience Excellence studentship, awarded to Maria Kekic in 2012. Ulrike Schmidt, Iain Campbell, and Anthony David receive salary support from the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Open access for this article was funded by King's College London. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: The authors have declared that no competing interests exist.

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