Antidepressant Use & Repetitive Transcranial Magnetic Stimulation (rTMS) in Anorexia

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While holding hope for the possibility of eating disorder recovery is important, it is also necessary to acknowledge that not everyone experiences full eating disorder recovery. 20 to 30% of individuals diagnosed with anorexia nervosa will have a severe and enduring form [1].

Researchers are attempting to reduce this number by constantly exploring new treatment modalities. One of these is a process known as Repeated Transcranial Magnetic Stimulation (rTMS).

What is Repeated Transcranial Magnetic Stimulation?

The most commonly used evidence-based treatment methods for eating disorders are predominantly psychological. rTMS differs from these in that it is “a form of non‐invasive brain stimulation that uses an electromagnetic field to alter neuronal activity in a target brain area [2].”

This treatment has been used since around 1985 to treat individuals with depressive symptoms when medication is not found to be helpful [3]. It typically takes between 30 to 60 minutes to perform.

During this time, a doctor will place an electromagnetic coil on the individual’s head that will generate magnetic pulses into their brain [3]. These pulses often feel like knocking or tapping on the head and do not cause pain [3].

Individuals that undergo this treatment are able to resume daily activities immediately after, including driving [3]. Side effects of rTMS may include lightheadedness, temporary hearing problems, mild headaches, tingling in the jaw or scalp, and a possible risk of seizures [3].

rTMS and Anorexia Nervosa

Just as with depression, rTMS is being considered as a treatment for those individuals who have undergone numerous treatment modalities with little to no success. One study has learned that “some patients felt more able to manage food‐related difficulties and had a more relaxed approach to food choices (e.g., trying new foods) after rTMS treatment [2].”

Woman using rTMS with eating disorder treatmentIt has also been found that “rTMS did not alter ratings of Healthiness and Tastiness nor did it change food choices by fat content. However, real rTMS may have contributed to reduced self‐control use in the Food Choice Task at post‐treatment [2].”

A recent study built upon this information in an attempt to learn how concurrent antidepressant use impacted the effects of rTMS treatment for severe and enduring anorexia nervosa. The study provided 20 sessions of rTMS along with treatment as usual to 26 patients and found that “antidepressant medication appears to enhance the response to rTMS with respect to ED symptoms but not to affective symptoms [1].”

Essentially, taking antidepressants while undergoing rTMS seems to result in eating disorder symptom improvement but not depressive symptom improvement [1]. Researchers are hoping to continue their research on concurrent medication use and rTMS treatment. This finding continues to broaden our awareness of how rTMS impacts mental illness symptoms and can be used to treat various disorders such as severe and enduring anorexia nervosa.


[1] Dalton, B. et al. (2021). A preliminary exploration of the effect of concurrent antidepressant medication on responses to high-frequency repetitive transcranial magnetic stimulation (rTMS) in severe, enduring anorexia nervosa. Journal of Eating Disorders, 9:16.

[2] Legg, T. L. (2020). Repetitive transcranial magnetic stimulation. Healthline. Retrieved from

[3] Dalton, B. et al. (2020). The effect of repetitive transcranial magnetic stimulation on food choice‐related self‐control in patients with severe, enduring anorexia nervosa. International Journal of Eating Disorders, 53:8.

About the Author:

Image of Margot Rittenhouse.Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published March 8, 2021, on
Reviewed & Approved on March 8, 2021, by Jacquelyn Ekern MS, LPC

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