TMS for Anorexia and Bulimia

A brain stimulation technique helps mood but not weight or binge behaviors

STUDY: Ewis DK et al, Annals of General Psychiatry 2026

STUDY TYPE: Systematic review and meta-analysis

FUNDING: Independent

Background

Transcranial Magnetic Stimulation (TMS) treats a wide variety of psychiatric disorders by targeting different brain regions. In the case of eating disorders, the prefrontal cortex and striatum may underlie the rigid, obsessive patterns of eating restriction. This meta-analysis looks at the clinical outcomes.

The Study

• 13 clinical trials pooled (7 anorexia, 6 bulimia), with 195 patients receiving active repetitive transcranial magnetic stimulation (TMS) and 132 receiving sham stimulation.
• Most trials targeted the left dorsolateral prefrontal cortex; session counts ranged from 1 to 30.

Results

In anorexia, TMS did not increase weight, but depression scores improved with a moderate effect size (0.41) in sham-controlled trials.

In uncontrolled single-arm analyses, eating disorder severity scores showed a moderate reduction (SMD: -0.50), though that signal weakens considerably when compared against sham.

TMS increased the urge to eat in anorexia nervosa and decreased it in bulimia nervosa patients. It’s interesting to think it has a disorder-specific effect, but it’s based on only two studies in each group.

Anxiety, binge frequency, and vomiting frequency didn’t improve.

There were no major risks or adverse effects with TMS.

Limitations

Small trials, protocols varied widely, and the effect sizes shrink when uncontrolled studies are set aside.

Practice Implications

1. Though encouraging for mood, the results are disappointing for core eating disorder symptoms with TMS.