Repetitive transcranial magnetic stimulation reduces cortisol concentrations in bulimic disorders

• Published in: Psychological medicine Vol. 41; no. 6; pp. 1329 - 1336
• Main Authors: Claudino, A. M., Van den Eynde, F., Stahl, D., Dew, T., Andiappan, M., Kalthoff, J., Schmidt, U., Campbell, I. C.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.06.2011
• Subjects: Adult; Adult and adolescent clinical studies; Biological and medical sciences; Bulimia; Bulimia nervosa; Bulimia Nervosa - physiopathology; Bulimia Nervosa - psychology; Bulimia Nervosa - therapy; Cortisol; Craving; Cues; Dominance, Cerebral - physiology; Eating behavior disorders; Electroconvulsive therapy; Energy Intake - physiology; Female; Food; Humans; Hydrocortisone - blood; Medical sciences; Miscellaneous; Motivation - physiology; Prefrontal Cortex - physiopathology; Psychology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Saliva - chemistry; Salivary cortisol; Stress; Transcranial magnetic stimulation; Transcranial Magnetic Stimulation - methods; Young Adult; craving; salivary cortisol; Binge eating; eating disorders; hypothalamic–pituitary–adrenal axis; repetitive transcranial magnetic stimulation; Corticosteroid; hypothalamic-pituitary-adrenal axis; Transcranial magnetic stimulation; Hypothalamohypophysoadrenal axis; Steroid hormone; Craving; Central nervous system; Antiinflammatory agent; Hydrocortisone; Eating disorder; Glucocorticoid; Encephalon; Bulimia; Adrenal hormone
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S0033291710001881

In people with bulimic eating disorders, exposure to high-calorie foods can result in increases in food craving, raised subjective stress and salivary cortisol concentrations. This cue-induced food craving can be reduced by repetitive transcranial magnetic stimulation (rTMS). We investigated whether rTMS has a similar effect on salivary cortisol concentrations, a measure of hypothalamic-pituitary-adrenal axis (HPAA) activity. We enrolled twenty-two female participants who took part in a double-blind randomized sham-controlled trial on the effects of rTMS on food craving. Per group, eleven participants were randomized to the real or sham rTMS condition. The intervention consisted of one session of high-frequency rTMS delivered to the left dorsolateral prefrontal cortex (DLPFC). Salivary cortisol concentrations were assessed at four time points throughout the 90-min trial. To investigate differences in post-rTMS concentrations between the real and sham rTMS groups, a random-effects model including the pre-rTMS cortisol concentrations as covariates was used. Salivary cortisol concentrations following real rTMS were significantly lower compared with those following sham rTMS. In this sample, there was also a trend for real rTMS to reduce food craving more than sham rTMS. These results suggest that rTMS applied to the left DLPFC alters HPAA activity in people with a bulimic disorder.