Binge eating during antipsychotic treatment: an exploratory trial combines cognitive training and brain stimulation

A feasibility trial in 28 adults

Weight gain associated with antipsychotics often occurs within the first three to six months of treatment, according to the background presented by the authors. However, the trial involved adults with schizophrenia or schizoaffective disorder already receiving stable doses of antipsychotics, rather than specifically people starting treatment.

The 28 participants were randomly assigned to two groups in a double-blind trial. All completed five sessions of food approach bias modification training, or ABMT, over three weeks. This training was combined with either active transcranial direct current stimulation, known as tDCS, or sham stimulation.

Assessments took place before the intervention, after it, and at a follow-up two weeks later. The primary objective concerned feasibility, including recruitment, attendance, retention and acceptability. Food cravings, binge-eating episodes and body mass index were among the secondary outcomes.

A signal for binge eating, but substantial uncertainty

The between-group comparison suggests an effect favoring active stimulation on binge-eating episodes: the standardized effect size is −0.6, with a 95% confidence interval ranging from −1.5 to 0.3. This interval includes zero. The result therefore remains compatible with no difference between the groups.

For food cravings, the signal instead favored the group receiving sham stimulation, again with a confidence interval that included zero. The results therefore do not show a consistent advantage for active stimulation across the eating behaviors studied.

The authors also report changes in food-related biases, followed by a decrease in binge-eating episodes, within the group receiving active stimulation. But improvement within one group alone is not enough to establish superiority over the comparison group.

What this trial cannot establish

Retention reached 85.7% after the intervention and 78.6% at follow-up. The authors consider the approach acceptable, but the abstract does not detail adverse events or tolerability results.

The abstract provides no numerical results on changes in body mass index. These data cannot establish that this approach prevents weight gain during antipsychotic treatment. Since all participants received cognitive training, the trial also cannot isolate its effect or demonstrate synergy with stimulation.

What we can take away

This combination warrants evaluation in a confirmatory trial. For now, the results mainly support its feasibility, not established effectiveness against binge eating or weight gain.