Transcranial Magnetic Stimulation
INTRODUCTION:
Currently, delivering repetitive
magnetic pulses known as ‘repetitive TMS’ or ‘rTMS’ is used for the treatment
of depression. Now, it is believed that this treatment could also help people
with eating disorders. The stimulation of rTMS affects an area of the brain
that eases the symptoms of depression and improves mood. It is not completely
understood why it works, but the results have been positive. [D]
Repetitive transcranial magnetic
stimulation (rTMS) 're-tunes' the brain to boost self-control. Transcranial
magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields
to stimulate nerve cells in the brain to improve symptoms of depression. TMS is
typically used when other depression treatments haven't been effective. [D]
Existing
treatments for people struggling with an eating disorder are found to be ineffective
for many patients. Magnets could help people with eating disorders regain
control of their lives. Patients with long-standing eating disorders remained
symptom-free for up to a year after a magnet was used to turn up the part of
the brain involved in self-control.
The procedure involves placing a magnetic coil
on the scalp. It involves placing a magnetic coil on the scalp and using it to
stimulate the brain’s electrical circuits. During a TMS session, an
electromagnetic coil is placed against your scalp near your forehead. The
electromagnet painlessly delivers a magnetic pulse that stimulates nerve cells
in the region of your brain involved in mood control and depression. And it may
activate regions of the brain that have decreased activity in people with depression.
[D]
Over or
under-active parts of the brain can be calmed down or jump-started. These simulations revealed a significant reduction in symptoms
of roughly half the participants in the study. Most remain well for three to
six months after treatment. [C]
An Eating Disorder [or ED] is any of a range of
psychological disorders characterized by abnormal eating habits. Anorexia
nervosa, bulimia, and binge eating disorder are just some examples. Individuals
struggling with ED tend to have extreme emotions, attitudes, and behaviors
about food and weight. Eating
disorders are serious emotional and physical problems that can have
life-threatening consequences.
Feeding and Eating
Disorders described in the American Psychiatric Association’s Fifth Edition of
the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in
2013.
Anorexia Nervosa is
when the individual experiences intense fear of weight gain, obsession with
weight, and persistent behavior to prevent weight gain. Food intake is very
low, self-esteem overly related to body image, and the inability to appreciate
the severity of the situation. Binge-Eating/Purging
Type involves binge eating and/or purging behaviors during the last
three months. Restricting Type
does not involve binge eating or purging.
Binge Eating Disorder
involves frequent episodes of consuming very large amounts of food but without
behaviors to prevent weight gain, such as self-induced vomiting. Individuals
are overwhelmed with a feeling of being out of control during these episodes.
Shame and guilt are often felt towards their binge eating. Indications that the
binge eating is out of control, such as eating when not hungry, eating to the
point of discomfort, or eating alone because of shame about the behavior.
Bulimia Nervosa
involves frequent episodes of consuming very large amount of food followed by
behaviors to prevent weight gain, such as self-induced vomiting. Similar to
binge eating episodes, a feeling of lack of control is experienced.
Other Specified
Feeding or Eating Disorder that are yet to be specified in DSM-IV [EDNOS] are
by their definition a feeding or eating disorder that causes significant
distress or impairment, but does not meet the criteria for another feeding or
eating disorder.
The sooner an ED is
discovered the greater the chances for recovery increases. It is critical to be
aware of warning signs and early symptoms. However, because symptoms vary with
each ED and an individual will not have every symptom at once it is difficult
to detect.
The emotional and
behavioral signs of an ED are dramatic weight loss, dieting, control of food
becoming primary concerns, dressing in layers to hide weight loss or stay warm,
refuses to eat certain foods [restrictions against whole categories of food],
denies feeling hungry, complains of constipation, abdominal pain, cold
intolerance, lethargy/or excess energy, preoccupied with overall details of
food, calories, carbohydrates, dieting, and weight, develops food rituals,
disappears after eating, fear of eating with others or in public, steals/hoards
food in strange places, uses excessive amounts of mouthwash/mints/ gum, drinks
excessive amounts of water or non-caloric beverages, and maintains excessive
rigid exercise regime [despite weather, fatigue, illness, or injury].
Unusual swelling of
cheeks or jaw area, stained teeth, withdraws from friends and activities,
appears bloated from fluid retention, frequently diets, creates lifestyle
schedules around their ‘binge-and-purge’ sessions and purges after a binge [self-induced
vomiting, abusing laxatives, diet pills, excessive exercise, and/or fasting]. Body
weight is typically within the normal weight range; may be overweight, extreme
mood swings.
Physical signs of ED include fluctuations in weight [both up and down],
stomach cramps [other non-specific
gastrointestinal complaints (constipation, acid reflux, etc.)], menstrual irregularities [missing periods or
only having a period while on hormonal contraceptives (this is not considered a
“true” period)], difficulties concentrating, abnormal laboratory findings [anemia,
low thyroid and hormone levels, low potassium, low white and red blood cell
counts], sleep problems, dental problems [enamel erosion, cavities, tooth
sensitivity], dizziness/fainting, feeling cold all the time, thinning of hair,
muscle weakness, and impaired immune functioning.
[These
steps are intended for use in a nonemergency situation. If the situation is a
medical or psychiatric emergency and the person is at risk of suicide or is
medically unstable, call 911 immediately.]
Early detection,
initial evaluation, and effective treatment are important steps that can help
an eating disorder sufferer move into recovery more quickly, preventing the
disorder from progressing to a more severe or chronic state. The following
assessments are recommended as the first steps to diagnosis and will help
determine the level of care needed. Receiving appropriate treatment is the
first step towards recovery. [A]
RESEARCH:
If repetitive transcranial magnetic stimulation (rTMS)
works, symptoms of depression tend to improve and even disappear completely.
However, it may take up to a few weeks of treatment for symptoms to relieve.
Researchers have noticed that TMS treatment may be less effective when a
patient’s mental illness tends to be detached from reality [i.e psychotic
symptoms], depression has lasted for several years, and/or if electroconvulsive
therapy (ECT) hasn't worked to improve depression symptoms. [D]
For patients with eating disorders who are not doing well
with medications and therapy, it might be worth discussing the option of rTMS
with the treating psychiatrist or general physician. Conditions such as ED’s
are much more complex and hard-wired than previously thought. Recent advances
in neuroscience have given us a better understanding of the functions of the brain.
People with eating disorders can find it very encouraging to know that it is
not their fault, they didn't choose to have this condition. We are hopeful that
this research will lead to a new, effective treatments being designed, but it
is early days. [C]
Ongoing studies
of rTMS will improve the techniques and effectiveness of treatments. Some of
the techniques researchers are aiming towards learning more about are the amount
of stimulations needed as well as the most effective regions to stimulate the
brain. Whether rTMS sessions can benefit depression is still ambiguous. This
involves continuing treatment when you are symptom-free with the hope that it
will prevent the return of symptoms. Most insurance companies don't cover
maintenance rTMS.
However, if your depression improves with rTMS, and then
later you have another episode of symptoms, your rTMS treatment can be
repeated. This is called re-induction. Some insurance companies will cover
re-induction. If your symptoms improve with rTMS, discuss ongoing or
maintenance treatment options for your depression with your doctor. [D]
Side effects for rTMS that are commonly associated with antidepressant
medications such as gastrointestinal upset, dry mouth, sexual dysfunction,
weight gain, or sedation, have not been reported by patients. However, about
half of the patients did report a common side effect of rTMS, which was headaches. These are mild and
generally diminish over the course of the treatment. Over-the-counter
pain medication can be used to treat these headaches. Only a few side-effects
were reported and only a small percentage of patients discontinue treatment
because of these. [E]
About one third of
patients may experience painful scalp sensations or facial twitching with rTMS
pulses. These too tend to diminish over the course of treatment although
adjustments can be made immediately in coil positioning and stimulation
settings to reduce discomfort. The rTMS machine produces a loud noise and
because of these earplugs are given to the patient to use during the treatment.
However, some patients may still complain of hearing problems immediately
following treatment. No evidence suggests these effects are permanent if
earplugs are worn during the treatment. [E]
The most serious risk
of rTMS is seizures. However, the risk of a seizure is exceedingly low. At
Johns Hopkins, we follow up-to-date safety guidelines that are designed to
minimize the risk of seizures. While rTMS is a safe procedure, it is important
to point out that because it is a new treatment, there may be unforeseeable
risks that are not currently recognized. [E]
Patients with any type of non-removable metal in
their heads (with the exception of braces or dental fillings), should not
receive rTMS. Failure to follow this rule could cause the object to heat up,
move, or malfunction, and result in serious injury or death. [E]
Existing evidence to date suggests that patients who are
less treatment-resistant respond better to rTMS than those who are highly
treatment-resistant. However, there is much yet to be learned about particular
variables that may impact response to rTMS. Researchers are presently
conducting clinical studies to evaluate who will benefit most from rTMS therapy.
For example, there is a lot of interest in evaluating whether rTMS with
antidepressant medications is more effective than rTMS alone. [E]
CONCLUSION:
All of those being treated had exhausted all conventional
options, including pills and psychotherapy, and many had been in and out of
hospital for years. The Canadian researchers say the brain-boosting treatment –
which is already used to ease depression – could be a valuable new weapon in
the fight against anorexia and bulimia.
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*Please note! These images are not mine. They were found on
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know so that I can give you credit for them! Also the people in the images have
no relation to the diseases, illnesses, or cancers I write about. Thanks so
much & enjoy~
Quotes found on: imdb.com/blackswan
Images found on: filmscreencaps.com/blackswan
Images found on: filmscreencaps.com/blackswan
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