Repetitive transcranial magnetic stimulation reduces cortisol concentrations in bulimic disorders

Claudino, Angélica Medeiros; Eynde, Fréderique Van den; Ståhl, Daniel; Dew, Tracy; Andiappan, Manoharan; Kalthoff, J.; Schmidt, Ulrike; Campbell, Iain C.

doi:10.1017/s0033291710001881

Cited by 25 publications

(30 citation statements)

References 52 publications

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“…There was also a non-significant tendency to show greater cortisol reduction in the final exposure session, compared to the first session, in the pure exposure group. These results are consistent with the expected positive effect on this neuroendocrine response of weight normalization and bulimic symptoms reduction in women with BN after successful treatment (Claudino et al, 2011;Field et al, 1998;Neudeck et al, 2001;Strong, 2010). One possible explanation is that as treatment progressed and the discomfort levels decreased throughout the sessions (and the positive thoughts and feelings increased), the patients perceived greater control and were more tolerant of negative emotions.…”

Section: Discussionsupporting

confidence: 79%

Testing the efficacy of pure versus guided mirror exposure in women with bulimia nervosa: A combination of neuroendocrine and psychological indices

Díaz-Ferrer

Rodríguez‐Ruiz

Ortega-Roldán

et al. 2015

Journal of Behavior Therapy and Experimental Psychiatry

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Section: Discussionsupporting

confidence: 79%

Testing the efficacy of pure versus guided mirror exposure in women with bulimia nervosa: A combination of neuroendocrine and psychological indices

Díaz-Ferrer

Rodríguez‐Ruiz

Ortega-Roldán

et al. 2015

Journal of Behavior Therapy and Experimental Psychiatry

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“…Interestingly, previous, single-session, sham-controlled, fast rTMS studies in healthy women showed no modulatory effects on the HPA axis after left or right DLPFC (Baeken et al, 2009b), although right DLPFC rTMS effects were observed, in another sample of healthy women, when controlling for baseline, state anxiety (Baeken et al, 2011). Other studies showed that fast rTMS over the left DLPFC decreased salivary cortisol levels in patients with depression (Baeken et al, 2009a) and bulimia (Claudino et al, 2010). The potent, polarity-dependent tDCS effects on the HPA axis observed in our study might be explained by the simultaneous bifrontal modulation, since previous models have suggested that HPA activity decreases or increases according to left and right DLPFC activity, respectively (Cerqueira et al, 2008).…”

Section: Discussionmentioning

confidence: 87%

Polarity- and valence-dependent effects of prefrontal transcranial direct current stimulation on heart rate variability and salivary cortisol

Brunoni

Vanderhasselt

Boggio

et al. 2013

Psychoneuroendocrinology

127

115

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Recent evidence has supported the notion that the hypothalamic-pituitary-adrenal (HPA) and the sympatho-adreno-medullary (SAM) systems are modulated by cortical structures such as the prefrontal cortex. This top-down modulation may play a major role in the neuroendocrine changes associated with stressful events. We aimed to investigate further this hypothesis by modulating directly prefrontal cortex excitability using transcranial direct current stimulation (tDCS) -a non-invasive, neuromodulatory tool that induces polaritydependent changes in cortical excitability -and measuring effects on salivary cortisol and heart rate variability as proxies of the HPA and SAM systems. Twenty healthy participants with no clinical and neuropsychiatric conditions were randomized to receive bifrontal tDCS (left anodal/right cathodal or left cathodal/right anodal) or sham stimulation, in a withinsubject design. During each stimulation session, after a resting period, subjects were shown images with neutral or negative valence. Our findings showed that excitability enhancing left anodal tDCS induced a decrease in cortisol levels. This effect is more pronounced during emotional negative stimuli. Moreover, vagal activity was higher during left anodal tDCS and emotional negative stimuli, as compared to sham stimulation and neutral images. We also observed an association between higher mood scores, higher vagal activation and lower cortisol levels for anodal stimulation. Subjective mood and anxiety evaluation revealed no specific changes after stimulation. Our findings suggest that tDCS induced transient, polarity specific modulatory top-down effects with anodal tDCS leading to a down-regulation of HPA and SAM systems. Further research using tDCS and neuroendocrine markers should explore the mechanisms of stress regulation in healthy and clinical samples.3

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“…However, Baeken et al (2011) found, in another sample, that rTMS decreased cortisol levels when controlling for baseline state anxiety. Other studies reported that rTMS decreased salivary cortisol levels in patients with depression (Baeken et al, 2009a) and bulimia (Claudino et al, 2010). Zwanzger et al (2003, 2007) evaluated rTMS effects on the “area under the curve” of cortisol response in two studies: in depressed patients, the authors explored whether therapeutical rTMS would change the cortisol response to the dexamethasone cortisol suppression test that is characteristically impaired in depression, finding no rTMS effects.…”

Section: Resultsmentioning

confidence: 90%

“…Of note, NIBS effects on these systems occurred mostly in the context of stress response – e.g., negative image visualization (Brunoni et al, 2012b) and 16 h fasting (Binkofski et al, 2011) or in clinical samples, such as depression (Baeken et al, 2009a), bulimia (Claudino et al, 2010), and anxiety (Baeken et al, 2011). Likewise, such effects occurred primarily during neuromodulation of DLPFC, an area implicated in the pathophysiology of stress and affective disorders (Koenigs and Grafman, 2009).…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Non-Invasive Brain Stimulation Therapies and Cardiovascular Risk: Implications for the Treatment of Major Depressive Disorder

Sampaio¹,

Fráguas²,

Lotufo³

et al. 2012

Front. Psychiatry

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Major depressive disorder (MDD) and cardiovascular diseases are intimately associated. Depression is an independent risk factor for mortality in cardiovascular samples. Neuroendocrine dysfunctions in MDD are related to an overactive hypothalamus-pituitary-adrenal (HPA) axis and increased sympathetic activity. Novel intervention strategies for MDD include the non-invasive brain stimulation (NIBS) techniques such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). In fact, although these techniques have being increasingly used as a treatment for MDD, their cardiovascular effects were not sufficiently investigated, which would be important considering the dyad MDD/cardiovascular disorders. We investigated this issue through a systematic review for published articles from the first date available to May 2012 in MEDLINE and other databases, looking for main risk factors and surrogate markers for cardiovascular disease such as: cortisol, heart rate variability (HRV), alcohol, smoking, obesity, hypertension, glucose. We identified 37 articles (981 subjects) according to our eligibility criteria. Our main findings were that NIBS techniques might be effective strategies for down-regulating HPA activity and regulating food, alcohol, and cigarette consumption. NIBS’s effects on HRV and blood pressure presented mixed findings, with studies suggesting that HRV values can decrease or remain unchanged after NIBS, while one study found that rTMS increased blood pressure levels. Also, a single study showed that glucose levels decrease after tDCS. However, most studies tested the acute effects after one single session of rTMS/tDCS; therefore further studies are necessary to investigate whether NIBS modifies cardiovascular risk factors in the long-term. In fact, considering the burden of cardiac disease, further trials in cardiovascular, depressed, and non-depressed samples using NIBS should be performed.

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Repetitive transcranial magnetic stimulation reduces cortisol concentrations in bulimic disorders

Abstract: These results suggest that rTMS applied to the left DLPFC alters HPAA activity in people with a bulimic disorder.

Cited by 25 publications

References 52 publications

Testing the efficacy of pure versus guided mirror exposure in women with bulimia nervosa: A combination of neuroendocrine and psychological indices

Testing the efficacy of pure versus guided mirror exposure in women with bulimia nervosa: A combination of neuroendocrine and psychological indices

Polarity- and valence-dependent effects of prefrontal transcranial direct current stimulation on heart rate variability and salivary cortisol

A Systematic Review of Non-Invasive Brain Stimulation Therapies and Cardiovascular Risk: Implications for the Treatment of Major Depressive Disorder

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