Abstract Objective This systematic review and meta-analysis aimed to evaluate the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in patients with anorexia nervosa (AN) and bulimia nervosa (BN), focusing on its impact on psychological, psychopathological, neurocognitive, and behavioral outcomes. Methods A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane CENTRAL from inception to May 2025. Eligible studies included clinical trials involving adult patients with AN or BN treated with rTMS. Data were pooled using fixed or random-effects models depending on heterogeneity. Mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated. Risk of bias was assessed using Cochrane RoB 2.0 and NIH tools. Results Thirteen studies were included, yielding a total of n = 195 active rTMS treatments and n = 132 sham treatments. Compared to sham, rTMS did not significantly improve BMI in AN patients (MD: 0.19; 95% CI: -0.50, 0.88; P = 0.59). A significant moderate reduction in eating disorder severity was found in single-arm analysis (31 patients, SMD: -0.50, 95% CI -0.90, -0.10, p = 0.01). Depression improved with rTMS over sham (105 patients, SMD: -0.41, 95% CI -0.81, -0.02, p = 0.04), while anxiety, binge frequency, and vomiting frequency did not. Urge to eat increased in AN (30 patients, MD: 1.20, 95% CI 0.20, 2.21, p = 0.02) and decreased in BN (25 patients, MD: -10.25, 95% CI -15.88, -4.62, p = 0.0004). No serious adverse events were reported. Conclusions rTMS shows potential in improving eating disorder severity and depressive symptoms in AN, with disorder-specific modulation of food-related urges. Its effects on BMI and behavioral symptoms remain inconclusive. rTMS was well tolerated.
Ewis et al. (2026) studied this question.