New research from Canada suggests that “deep brain stimulation” – a relatively simple surgical technique – may be effective in treating anorexia, a notion that Vero Beach clinical neuropsychologist Whitney Legler says carries promise.
Anorexia, a mental-health disorder that makes people lose more weight than is healthy, affects about 1 percent of the female population, mostly those between the ages of 12 and 25; it has the highest mortality rate of any mental illness.
The disease is characterized by an intense fear of gaining weight, an excessive concern with body weight, and a distorted body image: No matter how thin they get, the sufferer perceives themselves as being overweight. The malnutrition anorexia causes can lead to serious health issues, including a compromised immune system, weakened bones, and heart problems because of too-low levels of potassium in the blood.
As explained by Vero’s Dr. Legler, deep brain stimulation (DBS) is a neurosurgical procedure initially developed for the management of conditions that can cause people to have abnormal, involuntary or slow movements; such conditions include Parkinson’s disease, essential tremor disorder and Tourette syndrome. Dr. Legler says, “More recently, there has been interest in investigating the use of DBS for treatment of other circuit-based disorders, including psychiatric conditions such as depression, OCD, schizophrenia, and Alzheimer dementia.”
The 16 women who participated in the Canadian study chose to do so because they had tried other anorexia treatments without success, and were at risk of premature death. The youngest study participant was 21 and the oldest was 57. Some of the older participants had struggled with anorexia for decades. The group had an average body mass index (BMI) of 13.8, making them severely underweight (a healthy BMI range is 18.5 to 24.9).
The researchers were led by Dr. Nir Lipsman from the Sunnybrook Health Sciences Centre in Canada. He and his colleagues surgically implanted electrodes in a region of the brain called the “subcallosal cingulate.” This region is known to contain many receptors for serotonin; a serotonin deficit in the brain is associated with depression and anxiety. Serotonin has been shown to be out of balance in some people with anorexia.
The electrodes were used to stimulate the region on a continual basis for a full year. Although it sounds a bit like what Frankenstein did to his monster, the voltage used was low and few adverse reactions were reported.
When the trial was over, the researchers used a positron emission tomography (PET) scan to evaluate the brain activity of the 14 remaining participants. What they found was encouraging. There were positive changes in the regions of the brain linked to anorexia: increased activity in some areas, deceased activity in others. Additionally, mood and anxiety improved for five of these participants, and for 10 of them, symptoms of depression decreased. According to their own reporting, the participants’ quality of life also improved.
The deep brain stimulation technique also seemed to have a good effect on the weight of the participants. The first signs of weight gain began to show after three months; by the end of the study, the average BMI of the group increased by 25 percent, with six of the participants reaching a BMI in the normal range.
Although there are psychological, environmental and social factors that may lead to the development of anorexia, its exact causes are unknown. It sometimes runs in families; young women with a parent or sibling with an eating disorder are at higher risk of developing anorexia. Sufferers tend to be overachievers who come to believe that their lives would be better if they were thinner.
The standard treatment for anorexia is cognitive behavioral therapy, which focuses on changing thoughts and actions, minimizing negative thoughts about the act of eating and attempting to alter the harmful behaviors that fuel the disorder. Other forms of therapy, including family-based counseling, also are often part of the treatment mix. There are no medications that have been shown to work well in the treatment of anorexia. However, antidepressants and other psychiatric medications are sometimes used to treat the depression or anxiety that can accompany anorexia.
Dr. Legler says, “Most forms of medical management only focus on medical complications of anorexia. Treatments remain inadequate for most patients; only 30 percent make a complete recovery in their lifetime and roughly 10 percent of all patients diagnosed with anorexia die from starvation-related complications or suicide. This is the highest mortality rate seen for any mental illness.”
“Complementary” treatments – designed to reduce anxiety and promote relaxation – may help people with anorexia. Such treatments include acupuncture, yoga, massage and meditation.
The study on deep brain stimulation as a possible treatment approach for anorexia was published in the journal The Lancet Psychiatry. Study author Andres Lozano, from the University of Toronto in Canada, says, “Anorexia remains the psychiatric disorder with the highest mortality rate, and there is an urgent need to develop safe, effective, evidence-driven treatments that are informed by a growing understanding of brain circuitry.” The researchers say, and Dr. Legler agrees, that larger studies are now needed.
Additional information and resources can be found at www.eatingdisorderhope.com/treatment-centers/florida-fl. Dr. Legler’s office is located at 3003 Cardinal Drive, Suite A on the barrier island; the office phone is 772-231-5554.
