Page 221 - EJMO-9-2

Eurasian Journal of Medicine

and Oncology

ORIGINAL RESEARCH ARTICLE
Efficacy of repetitive transcranial magnetic

stimulation combined with horticultural therapy
for post-stroke depression: A randomized

controlled trial

1
1
Ying Chen 1,2 , Sarisak Soontornchai * , Pimporn Thongmuang * , Lu Ye 2 ,
and Xiaoqiang Qiu 3
1 Doctor of Public Health Program, Graduate School, Suan Sunandha Rajabhat University, Bangkok, Thailand
2 Department of Rehabilitation Medicine, Faculty of Medicine, International Zhuang Medicine Hospital
Affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi, China
3 Department of Epidemiology, School of Public Health, Guangxi Medical University, Nanning,
Guangxi, China

Abstract
*Corresponding authors:
Sarisak Soontornchai Post-stroke depression (PSD) affects approximately one-third of stroke survivors, and
(sarisak.so@ssru.ac.th);
Pimporn Thongmuang current treatments often present limitations. Non-invasive therapies such as repetitive
(pimporn.th@ssru.ac.th) transcranial magnetic stimulation (rTMS) and horticultural therapy (HT) are gaining
Citation: Chen Y,Soontornchai S, interest as alternative approaches. This study aimed to evaluate the clinical efficacy of
Thongmuang P, Ye L, Qiu X. rTMS combined with HT in treating PSD. Eighty PSD patients (aged 30 – 75 years old;
Efficacy of repetitive transcranial 1 month – 2 years post-stroke), diagnosed according to the Chinese Expert Consensus
magnetic stimulation combined
with horticultural therapy for post- on Clinical Practice of Post-Stroke Depression, were randomly assigned to one of four
stroke depression: A randomized treatment groups: Group A (antidepressant alone—escitalopram, 10 mg/day), Group B
controlled trial. Eurasian J Med (antidepressant + rTMS), Group C (antidepressant + HT), and Group D (antidepressant +
Oncol. 2025;9(2):213-223.
doi: 10.36922/EJMO025080032 rTMS + HT). rTMS was administered to the left dorsolateral prefrontal cortex (10 Hz, 110%
motor threshold, 15 min/session, 5 days/week), while HT consisted of 45-min gardening
Received: February 17, 2025
activities (e.g., planting, pruning, watering) conducted 5 days/week. Patients were
Revised: April 4, 2025 evaluated using the Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA),
Accepted: April 8, 2025 and Stroke-Specific Quality of Life Scale (SS-QOL) before and after the 28-day intervention.
Seventy-seven patients completed the trial, with three dropouts. All groups showed
Published online: April 29, 2025
significant reductions in HAMD and HAMA scores post-treatment compared to baseline
Copyright: © 2025 Author(s). (p<0.01). Group D demonstrated a statistically significant improvement in SS-QOL scores
This is an Open-Access article (p<0.01), while other groups did not (p>0.01). No significant difference in HAMD scores
distributed under the terms of the
Creative Commons Attribution was found between Groups B and C (p=0.399). These results suggest that combining rTMS
License, permitting distribution, and HT provides greater benefits in managing PSD compared to either intervention alone.
and reproduction in any medium, No serious complications were reported. This study supports the integration of rTMS and
provided the original work is
properly cited. HT as an effective adjunct to standard antidepressant therapy for PSD.
Publisher’s Note: AccScience
Publishing remains neutral with Keywords: Horticultural therapy; Repetitive transcranial magnetic stimulation;
regard to jurisdictional claims in
published maps and institutional Depression; Stroke; Stroke rehabilitation
affiliations.

Volume 9 Issue 2 (2025) 213 doi: 10.36922/EJMO025080032