Effects of Transcranial Direct Current Stimulation Treatment for Anorexia Nervosa

Silvie Baumann; Tadeáš Mareš; Jakub Albrecht; Martin Anders; Kristýna Vochosková; Martin Hill; Josef Bulant; Anna Yamamotová; Ota Štastný; Tomáš Novák; Petra Holanová; Alena Lambertová; Hana Papežová

doi:10.3389/fpsyt.2021.717255

Effects of Transcranial Direct Current Stimulation Treatment for Anorexia Nervosa

Front Psychiatry. 2021 Oct 6:12:717255. doi: 10.3389/fpsyt.2021.717255. eCollection 2021.

Authors

Silvie Baumann^{1

2}, Tadeáš Mareš^{2

3}, Jakub Albrecht^{2

3}, Martin Anders^{2

3}, Kristýna Vochosková^{1

4}, Martin Hill⁵, Josef Bulant^{3

5

6}, Anna Yamamotová⁷, Ota Štastný⁴, Tomáš Novák^{1

4}, Petra Holanová^{2

3}, Alena Lambertová^{2

3}, Hana Papežová^{2

3}

Affiliations

¹ Department of Psychotherapy, National Institute of Mental Health, Klecany, Czechia.
² First Faculty of Medicine, Charles University, Prague, Czechia.
³ Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czechia.
⁴ Third Faculty of Medicine, Charles University, Prague, Czechia.
⁵ Department of Steroid Hormones and Proteohormones, Institute of Endocrinology, Prague, Czechia.
⁶ Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.
⁷ Department of Physiology, Third Faculty of Medicine, Charles University, Prague, Czechia.

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.

Keywords: EDE-Q; Zung scale of depression; anorexia nervosa; brain stimulation; self-perception; tDCS; transcranial direct current stimulation.

Associated data

ClinicalTrials.gov/NCT03273205