Page 222 - EJMO-9-2

Eurasian Journal of
Medicine and Oncology RCT of rTMS combined with HT for PSD

1. Introduction with rTMS will be more effective in treating PSD than
rTMS or gardening therapy alone. To test this hypothesis,
Post-stroke depression (PSD) is a common affective we propose a 28-day double-blind, randomized controlled
disorder that occurs following a stroke, characterized trial (RCT), followed by a 6-month follow-up assessment,
by physical symptoms, a depressed mood, psychomotor to evaluate the clinical efficacy of HT combined with rTMS
retardation, and loss of interest. Stroke, a prevalent in the treatment of PSD and compare outcomes across the
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cardiovascular disease with high rates of disability and different intervention groups.
mortality, frequently results in motor impairments and
neuropsychological disorders, including PSD, cognitive 2. Study design
dysfunction, and language impairments. Approximately
2
one-third of stroke patients develop PSD, with its incidence This study was a double-blind RCT conducted at the
peaking within 3 months to 1 year post-stroke, affecting Department of Rehabilitation Medicine, Guangxi
over 50% of patients during this period. PSD imposes a International Zhuang Medicine Hospital (The Affiliated
3,4
significant burden on patients, their families, and society. Hospital of Guangxi University of Traditional Chinese
In China, the hospital-reported prevalence of PSD is Medicine, a tertiary care hospital) in Nanning, Guangxi,
estimated at 39.5%. 5 China, from March 2024 to December 2024. Ethical
approval was obtained from the Guangxi International
Current treatments for PSD include psychological Zhuang Medicine Hospital Institutional Review Board
management, pharmacological therapies, traditional (approval number: 2022-042-01), and the trial was
Chinese medicine (TCM), and physical therapies. TCM registered with the China Clinical Trials Registry
6
7
treatments – such as Wuling capsules, flavored Banxia- (registration number: MR-45-23-041506).
Houpu decoction, and Chaihu Shugan San – combined
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with acupuncture and other external techniques, have 2.1. Participants
shown promising efficacy with fewer adverse effects.
Physical therapies, including exercise therapy, hyperbaric 2.1.1. Diagnostic criteria
oxygen therapy, and repetitive transcranial magnetic Participants were diagnosed with PSD according to the
stimulation (rTMS), are also utilized; however, these Chinese Expert Consensus on Clinical Practice of Post-
methods are often associated with high costs, inconsistent Stroke Depression. Depressive symptoms were observed
efficacy, and potential adverse effects. As a result, non- within 1 month – 2 years after stroke onset. Diagnosis was
pharmacological interventions like horticultural therapy supported by the Hamilton Depression Scale (HAMD),
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(HT) have gained increasing attention in recent years. Hamilton Anxiety Scale (HAMA), and Stroke-Specific
15
rTMS is a non-invasive neural stimulation technique Quality of Life Scale (SS-QOL). 16
that uses pulsed magnetic fields to modulate the activity 2.1.2. Inclusion criteria
of the central nervous system. It has been shown to
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promote neural network reconstruction, stimulate neural Participants were eligible if they met the following criteria:
progenitor cell differentiation and proliferation, and (i) Fulfilled the diagnostic criteria for PSD; (ii) aged
alleviate depression symptoms. On the other hand, HT between 30 and 75 years; (iii) had stable vital signs, were
involves engagement with plants and natural environments conscious, and demonstrated good compliance; (iv) had a
to reduce stress and improve mental well-being. Studies HAMD score ≥7; (v) had not received antidepressant or
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have indicated that HT can effectively alleviate depressive other treatments that could affect the study results within
symptoms, making it a valuable therapy for PSD. 2 weeks before enrollment; and (vi) provided informed
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According to the Chinese Expert Consensus on the Clinical consent, signed by the patient or their legal guardian.
Practice of Post-Stroke Depression, HT is not currently 2.1.3. Exclusion criteria
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included as a recommended intervention; however, its use
has expanded rapidly in recent years, with an increasing Participants were excluded if they met any of the following
number of hospitals exploring HT as a treatment for PSD. conditions: (i) Had a history of psychiatric disorders;
This study aims to combine HT with rTMS to develop a (ii) had significant dysfunction of other vital organs;
non-invasive, cost-effective, and replicable treatment (iii) were diagnosed with malignancies such as tumors;
approach for PSD. By examining the potential synergistic (iv) had metallic or ferromagnetic implants; (v) had
effects of these therapies, we seek to provide innovative severe consciousness disorders, coma, aphasia, cognitive
therapeutic options for managing PSD and improving impairment, or deafness affecting communication;
patient outcomes. We hypothesize that, when administered (vi) refused to participate in the study; (vii) had hearing
alongside standard antidepressant, the combination of HT impairments; (viii) had a history of epilepsy.

Volume 9 Issue 2 (2025) 214 doi: 10.36922/EJMO025080032