rTMS for Anorexia Nervosa
(FED Trial)
Trial Summary
What is the purpose of this trial?
Currently, Family Based Treatment (FBT) is the leading evidence-based, manualized treatment for adolescents with anorexia nervosa (AN). FBT emphasizes parental involvement in addressing disordered eating by supporting the child in eating and refeeding to achieve a healthy body weight and independent eating. Based on multiple RCTs, 50% of AN patients who receive FBT recover, and those who do not are more likely to develop a chronic illness. Research demonstrates that weight gain of less than 2.3kg (4.8 pounds) by week 4 of FBT predicts that 75% of adolescents with AN will not achieve weight restoration by the end of treatment. FBT works in part by reducing the avoidance of food and increasing the exposure to food triggers, like the treatment of anxiety disorders and obsessive-compulsive disorder (OCD). Thus, researchers postulate that anxiety may be a negative predictor of FBT treatment outcome in the early phase of FBT. In addition, elevated baseline anxiety has been shown to be associated with poorer outcomes at end of treatment and may also impact the likelihood of early response. To improve clinical response, we need to develop viable biological treatment targets (i.e., brain areas implicated in anxiety) that could be combined with FBT. Such targets can be defined by 1) initially targeting brain areas that mediate symptoms hindering treatment response (i.e., anxiety), and 2) looking at changes in brain chemistry and function. Thus, repetitive transcranial magnetic stimulation (rTMS) could be an alternative and promising treatment approach for adolescents with AN who do not respond to Phase 1 of FBT. Using rTMS, we can target the brain areas implicated in anxiety in people with anorexia and modulate that activity to reduce symptoms, and thus, facilitate response to FBT. Several studies have shown the rTMS to the right dorsolateral prefrontal cortex (DLPFC) is effective in reducing anxiety across a range of neuropsychiatric disorders. Therefore, it is possible that stimulating the right DLPFC could facilitate treatment efficacy of FBT in youth with AN. Additional explorations of the connections between, and neurochemistry of, the right DLPFC and those mediating emotion in the brain (e.g., amygdala) could aid in our understanding of the networks impeding effective treatment responses and allow for more tailored, precision targeting with TMS.
Will I have to stop taking my current medications?
You can continue taking your current medications as long as the dose has been stable for six weeks before the trial and you agree not to change the medication or dosage during the trial period.
What data supports the effectiveness of the treatment Repetitive Transcranial Magnetic Stimulation (rTMS) for Anorexia Nervosa?
Research shows that rTMS, a treatment that uses magnetic fields to stimulate the brain, may help reduce symptoms of anorexia nervosa, such as feeling full or anxious, and is safe and well-tolerated. Studies involving people with severe anorexia nervosa have shown improvements in symptoms after receiving rTMS sessions.12345
Is rTMS safe for people with anorexia nervosa?
How does rTMS treatment differ from other treatments for anorexia nervosa?
rTMS (repetitive transcranial magnetic stimulation) is unique because it is a brain-directed treatment that uses magnetic fields to stimulate specific areas of the brain, like the dorsolateral prefrontal cortex, which may help reduce symptoms of anorexia nervosa. Unlike traditional therapies that focus on psychological or nutritional interventions, rTMS directly targets neural circuits involved in food choice and eating behaviors.34568
Research Team
Frank P MacMaster, PhD
Principal Investigator
University of Calgary
Eligibility Criteria
This trial is for adolescents aged 12 to 18 with Anorexia Nervosa, as confirmed by medical and psychiatric assessment. Participants must be medically stable, fluent in English, and on a steady dose of any AN or psychiatric medications for six weeks prior without plans to change during the study.Inclusion Criteria
Exclusion Criteria
Timeline
Screening
Participants are screened for eligibility to participate in the trial
Family Based Treatment (FBT) Phase 1
Participants undergo Family Based Treatment (FBT) focusing on parental involvement to address disordered eating and achieve healthy body weight
Repetitive Transcranial Magnetic Stimulation (rTMS)
Participants receive rTMS targeting the right dorsolateral prefrontal cortex to reduce anxiety and facilitate response to FBT
Follow-up
Participants are monitored for changes in anxiety and weight restoration after treatment
Treatment Details
Interventions
- Repetitive Transcranial Magnetic Stimulation
Find a Clinic Near You
Who Is Running the Clinical Trial?
University of Calgary
Lead Sponsor
University of Alberta
Collaborator