Efficacy of Non-invasive Vagus Nerve Stimulation for Treatment of Low Weight Eating Disorders

This project includes a 4-week randomized trial comparing pre-meal vagal nerve stimulation (taVNS) to pre-meal sham stimulation. The aims will assess if taVNS results in greater satisfaction, greater calorie consumption, less self-reported fullness, decrease in eating disorder symptoms, and less anxiety than sham stimulation.

Study Overview

• Status: Recruiting
• Conditions: Anorexia Nervosa
• Intervention / Treatment: Device: taVNS; Device: Sham

Detailed Description

The purpose of this research study is to determine the safety and ability of a device that will stimulate the vagus nerve (taVNS), in 30 adolescents ages 14-17. This project will explore if stimulation has any effect on eating behaviors in individuals with eating disorders, such as Anorexia Nervosa. Study measurements include eating behavior and other measures of behavior. These measurements will take place before and in response to the nerve stimulation during the course of a 4-week randomized trial.

Participants are assigned to one of two conditions: 1) Vagal Nerve Stimulation (n=20; this group includes use of the vagus nerve stimulator with stimulation); and 2) Sham Stimulation (n=10; this group includes use of the vagus nerve stimulator with no stimulation). Screening to determine eligibility includes physical measurements of height and weight, interview questions to determine inclusion/exclusion criteria and eating disorder diagnoses, and online REDCap surveys.

If eligible, participants will be scheduled for 5 study visits. Procedures will include taVNS, single item meals, check-ins during treatment in the Eating and Weight Disorders Program, and self-report questionnaires.

Clinic check-ins (3 days per week while in the clinic during the 4 week intervention) will include taVNS stimulation or sham for 30 minutes. Study Visits (4 weekly study visits lasting 1 hour each) will include a single item meal test, self-report surveys, and adverse event assessment and documentation. The follow-up visit, lasting 1 hour, will take place 1 week after the final study visit and includes self-report surveys and adverse event assessment and documentation.

• Study Type: Interventional
• Enrollment (Estimated): 30
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Tom Hildebrandt, PsyD; Phone Number: 212-659-8673; Email: tom.hildebrandt@mssm.edu
• Study Contact Backup: Name: Jessica Bibeau, MA; Phone Number: 212-659-8724; Email: jessica.bibeau@mssm.edu

Study Locations

• United States
  • New York
    • New York, New York, United States, 10029
      • Recruiting
      • Department of Psychiatry, Eating and Weight Disorders Program
      • Contact: Jessica Bibeau, MA; Phone Number: 212-659-8724; Email: jessica.bibeau@mssm.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years to 17 years (Child, Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Ages 14-22
• Engaged in standardized refeeding in the EWDP during the intervention (may include individuals with anorexia nervosa or avoidant/restrictive food intake disorder)
• Needing to gain at least 8 lbs during the refeeding period
• English-speaking

Exclusion Criteria:

• Pregnancy
• GI disturbance or diagnosis (Crohn's disease, diverticulitis, irritable bowel syndrome, gastric bezoar, or suspected or known GI obstruction)
• GI surgery in the last 3 months
• Implanted or portable electro-mechanical device such as a pacemaker, defibrillator, or infusion pump
• Allergies to the ingredients in the shake provided
• Use of illicit substances including misuse, overuse, abuse, illegal use, or addiction to or dependence on
• Acute suicide risk/active suicidal ideation determined with the C-SSRS. "Yes" to questions 1 or 2 in the Suicidal Ideation section or "Yes" to any question in the Suicidal Behavior section will be exclusionary
• Psychiatric diagnoses of schizophrenia or bipolar disorder

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Vagal Nerve Stimulation (taVNS); taVNS stimulation administered during intervention	Device: taVNS; Participants will receive vagal nerve stimulation approximately 3 days a week for 30 minutes over the course of 4 weeks while they are attending treatment for Anorexia Nervosa in the Eating and Weight Disorder Intensive Program.
Sham Comparator: Sham Stimulation (Sham); Sham stimulation administered during intervention	Device: Sham; Participants will receive sham stimulation approximately 3 days a week for 30 minutes over the course of 4 weeks while they are attending treatment for Anorexia Nervosa in the Eating and Weight Disorder Intensive Program.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Satisfaction Rating Scale	Treatment satisfaction will be measured using a 10-point rating scale at the follow-up visit, with range from 0 to 10. A higher score will indicate higher level of satisfaction.	4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent of participants with treatment-related adverse events	Safety will be measured by documenting treatment-related adverse events during the 4 weeks of treatment. Occurrences will be reported according to % of participants experiencing a treatment-related adverse event.	4 weeks
Dropout Rate	Tolerability of treatment will be measured using dropout rates. The drop out rate will be reported according to % of participants dropping before the completion of the follow-up visit.	4 weeks
Total calories consumed	Autonomous eating will be measured in total calories consumed during 4 study visits. Total calories consumed will be calculated between study visit 1 and study visit 4.	up to 4 weeks
Change in weight from baseline to 4 weeks	Weight will be measured in the EWDP IP clinic by study staff during all study visits. Change in weight will be calculated using the baseline and 4-week measurements.	baseline and week 4
Change in the Clinical Impairment Assessment (CIA)	Impairment is measured using the Clinical Impairment Assessment, which is a 16-item self-report measure of impairment from eating disorders. Responses are scored using 0, 1, 2, or 3 and the score is calculated using the sum of all items. Possible scores range between 0 - 48, with higher scores indicating more impairment and lower scores indicating less impairment. Change in impairment will be calculated using the baseline and 4-week scores from CIA.	baseline and week 4
Change in the Eating Disorder Examination (EDE-Q)	Change in eating disorder symptoms will be measured using the EDE-Q, which is a 28-item self-report measure assessing eating disorder symptoms. Each subscale (Restraint, Eating Concern, Shape Concern and Weight Concern) is scored 0-6. A global score (total scale from 0-6) is calculated by summing 4 subscales and then dividing by 4. A score of 4 or higher is considered clinically significant. Change in EDE-Q global score will be calculated using the baseline and 4-week scores.	baseline and week 4
Change the Center for Epidemiological Studies Depression Scale (CESD)	Change in depression will be measured using the CESD, which is a 20-item self-report measure evaluating depressive symptoms. Total scores from 0 to 60. A higher score indicates higher levels of depressive symptoms. Change in CESD score will be calculated using the baseline and 4-week scores.	baseline and week 4
Change the Anxiety Sensitivity Index (ASI)	Change in anxiety will be measured using the ASI, which is an 18-item self-report measure used to assess anxiety sensitivity. Total scores from 0-48. A higher score indicates more impairment. Change in ASI total score will be calculated using the baseline and 4-week scores.	baseline and week 4
Change in the Visceral Sensitivity Index (VSI)	Changes in gastrointestinal-specific anxiety will be measured using the VSI, which is a 15-item measure. Total scores range from 0 (no GI-specific anxiety) to 75 (severe GI-specific anxiety). Higher scores indicate greater GI-specific anxiety. Change in VSI total score will be calculated using the baseline and 4-week scores.	baseline and week 4
Change in hunger using a Visual Analogue Scale (VAS)	Change in hunger will be measured using a 15-cm visual analog scale. The total score ranges from 0-15, with higher ratings indicating greater hunger. Change in hunger will be calculated using the baseline and 4-week ratings.	baseline and 4 weeks
Change in fullness using a Visual Analogue Scale (VAS)	Change in fullness will be measured using a 15-cm visual analog scale. The total score ranges from 0-15, with higher ratings indicating greater fullness. Change in fullness will be calculated using the baseline and 4-week ratings.	baseline and 4 weeks
Change in sickness using a Visual Analogue Scale (VAS)	Change in sickness will be measured using a 15-cm visual analog scale. The total score ranges from 0-15, with higher ratings indicating greater sickness. Change in sickness will be calculated using the baseline and 4-week ratings.	baseline and 4 weeks
Change in control using a Visual Analogue Scale (VAS)	Change in control will be measured using a 15-cm visual analog scale. The total score ranges from 0-15, with higher ratings indicating greater control. Change in control will be calculated using the baseline and 4-week ratings.	baseline and 4 weeks
Change in urge to eat using a Visual Analogue Scale (VAS)	Change in urge to eat will be measured using a 15-cm visual analog scale. The total score ranges from 0-15, with higher ratings indicating a greater urge to eat. Change in urge to eat will be calculated using the baseline and 4-week ratings.	baseline and 4 weeks
Change in thoughts of food using a Visual Analogue Scale (VAS)	Change in thoughts of food will be measured using a 15-cm visual analog scale. The total score ranges from 0-15, with higher ratings indicating greater thoughts of food. Change in thoughts of food will be calculated using the baseline and 4-week ratings.	baseline and 4 weeks
Change in disgust using a Visual Analogue Scale (VAS)	Change in disgust will be measured using a 15-cm visual analog scale. The total score ranges from 0-15, with higher ratings indicating greater disgust. Change in disgust will be calculated using the baseline and 4-week ratings.	baseline and 4 weeks
Change in fear using a Visual Analogue Scale (VAS)	Change in fear will be measured using a 15-cm visual analog scale. The total score ranges from 0-15, with higher ratings indicating greater fear. Change in fear will be calculated using the baseline and 4-week ratings.	baseline and 4 weeks
Change in the Gastroparesis Cardinal Symptom Index (GCSI)	Change in gastroparesis will be measured using the GCSI, which is a 6-item measure. Full scale from 0-5. Higher scores indicate more discomfort. Change in GCSI total score will be calculated using the baseline and 4-week scores.	baseline and 4 weeks
Change in the Disgust Scale-Revised (DS-R)	Change in disgust will be measured using the DS-R, which is a 27-item measure assessing degree of disgust associated with food. Scores range from 0 - 100 and higher scores indicate a higher level of disgust. Change in DS-R total score will be calculated using the baseline and 4-week scores.	baseline and 4 weeks

Collaborators and Investigators

• Sponsor: Icahn School of Medicine at Mount Sinai
• Investigators: Principal Investigator: Tom Hildebrandt, PsyD, Icahn School of Medicine at Mount Sinai

Publications and helpful links

General Publications

• Andersson P, Jamshidi E, Ekman CJ, Tedroff K, Bjorkander J, Sjogren M, Lundberg J, Jokinen J, Desai Bostrom AE. Anorexia Nervosa With Comorbid Severe Depression: A Systematic Scoping Review of Brain Stimulation Treatments. J ECT. 2023 Dec 1;39(4):227-234. doi: 10.1097/YCT.0000000000000922. Epub 2023 Apr 14.

Study record dates

Study Major Dates

• Study Start (Actual): December 13, 2022
• Primary Completion (Estimated): October 1, 2026
• Study Completion (Estimated): October 1, 2026

Study Registration Dates

• First Submitted: September 21, 2022
• First Submitted That Met QC Criteria: September 21, 2022
• First Posted (Actual): September 26, 2022

Study Record Updates

• Last Update Posted (Estimated): October 7, 2025
• Last Update Submitted That Met QC Criteria: October 1, 2025
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Feeding and Eating Disorders; Anorexia Nervosa
• Other Study ID Numbers: STUDY-21-01790

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Anonymized data can be made available upon request.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: No