Abstract
Background: Anorexia nervosa (AN) is a life-threatening illness with poor treatment outcomes. Although transcranial direct current stimulation (tDCS) is a promising non-invasive brain stimulation method, its effect in patients with AN remains unclear.Objective: This study investigated changes in maladaptive eating behavior, body mass index (BMI), and depression after 10 sessions of anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC).Methods: In this double-blind, randomized controlled trial, 43 inpatients with AN were divided to receive either active (n = 22) or sham (n = 21) tDCS over the left DLPFC (anode F3/cathode Fp2, 2 mA for 30 min). All patients filled the Eating Disorder Examination Questionnaire (EDE-Q) and Zung Self-Rating Depression Scale (ZUNG), and their BMI was measured. These values were obtained repeatedly in four stages: (1) before tDCS treatment, (2) after tDCS treatment, (3) in the follow-up after 2 weeks, and (4) in the follow-up after 4 weeks.Results: Primary outcomes (EDE-Q) based on the ANOVA results do not show any between-group differences either after the active part of the study or in the follow-up. Secondary analysis reveals a reduction in some items of EDE-Q. Compared with sham tDCS, active tDCS significantly improved self-evaluation based on body shape (p < 0.05) and significantly decreased the need of excessive control over calorie intake (p < 0.05) in the 4-week follow-up. However, the results do not survive multiple comparison correction. In both sham and active groups, the BMI values improved, albeit not significantly.Conclusion: We did not observe a significant effect of tDCS over the left DLPFC on complex psychopathology and weight recovery in patients with AN. tDCS reduced the need to follow specific dietary rules and improved body image evaluation in patients with AN. Tests with a larger sample and different positions of electrodes are needed.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03273205.
Highlights
Anorexia nervosa (AN) is a serious life-threatening illness, which is found throughout all countries and all socioeconomic layers
We aimed to explore the effect of anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC) and with the cathode over the right orbitofrontal region in the first randomized, double-blind, sham-controlled trial of 43 patients with AN
We aimed to explore the effects of 10 sessions over the left DLPFC in patients with AN
Summary
Anorexia nervosa (AN) is a serious life-threatening illness, which is found throughout all countries and all socioeconomic layers. AN is estimated to occur in 0.3–1.0% females and 0.1–0.3% males [1, 2] It is associated with the highest mortality rate among all mental disorders (5.1 deaths per 1,000 person/years), and the suicide rate for AN is 1.3 per 1,000 person/years [3]. AN is a severe eating disorder characterized by deliberate weight loss induced and maintained purposefully by the patient. This disorder is associated with specific psychopathology, in which the intense fear of weight gain persists as an intrusive thought. Anorexia nervosa (AN) is a life-threatening illness with poor treatment outcomes. Transcranial direct current stimulation (tDCS) is a promising non-invasive brain stimulation method, its effect in patients with AN remains unclear
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