Page 226 - EJMO-9-2

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

4. Discussion Reduced levels of peripheral and central brain-derived
neurotrophic factor (BDNF) have been consistently
This study demonstrated significant improvements in observed in individuals with depression, including those
anxiety and depression among all enrolled participants. with PSD. 19-23 BDNF plays a critical role in neuroplasticity,
Post-intervention analysis revealed that Groups B, C, and neuronal survival, and synaptic connectivity – all of which
D achieved significantly better outcomes than Group A, are compromised in depressive disorders. rTMS has
with Group D (combined HT and rTMS) showing the been shown to upregulate BDNF expression, potentially
most pronounced improvements. Analysis of HAMA helping reverse these neurobiological deficits. In addition,
scores indicated that Group B (rTMS alone) outperformed
Group C (HT alone). However, no statistically significant glutamate has emerged as another key biomarker for
difference in HAMD scores was found between these treatment response, with increased radiolabeled activity
two groups. These findings are detailed in Table 3. The observed in the dorsolateral prefrontal cortex following
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most effective treatment outcome was achieved with rTMS stimulation. This suggests that rTMS plays a role in
the combination of antidepressants, rTMS, and HT modulating excitatory neurotransmission, which is often
(Group D), followed by the antidepressant and rTMS disrupted in depression.
group (Group B), and the antidepressant and HT group Furthermore, rTMS has been associated with increased
(Group C), respectively. dopamine concentrations 25-27 and enhanced functional
activity in neural networks involved in mood regulation,
Table 3. Post‑intervention comparison between all groups as demonstrated by functional imaging studies. These
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Outcome Group 1 Group 2 AD p changes may contribute to the alleviation of depressive
HAMD score A (19.78±2.49) B (16.44±1.46) 3.333 <0.01 symptoms by restoring balance within disrupted neural
(post-intervention) A (19.78±2.49) C (17.11±3.12) 2.667 <0.01 circuits. However, the precise mechanisms by which
rTMS exerts its therapeutic effects remain an area of active
A (19.78±2.49) D (14.44±2.04) 5.333 <0.01 investigation. A deeper understanding of these pathways
B (16.44±1.46) C (17.11±3.12) −0.667 0.399 could provide insights into the pathophysiology of PSD
B (16.44±1.46) D (14.44±2.04) 2 0.013 and aid in identifying novel therapeutic targets.
C (17.11±3.12) D (14.44±2.04) 2.667 <0.01 Accelerated rTMS protocols have been successfully
HAMA score A (23.33±2.00) B (19.33±2.35) 4 <0.01 employed in other populations, such as individuals with
(post-intervention) A (23.33±2.00) C (21.00±1.75) 2.333 <0.01 treatment-resistant depression and alcohol withdrawal

A (23.33±2.00) D (17.39±2.66) 5.944 <0.01 cravings. 29-32 In addition, studies have explored the use
B (19.33±2.35) C (21.00±1.75) −1.667 0.027 of rTMS in acute stroke care for managing complications
B (19.33±2.35) D (17.39±2.66) 1.944 0.011 unrelated to depression. 33-36 Despite these advances,
similar paradigms have not been widely applied in PSD
C (21.00±1.75) D (17.39±2.66) 3.611 <0.01
Notes: Data are expressed as AVG±SD. Significance was set at p<0.05 populations. In this study, patients in Groups B and D
received rTMS treatment at a frequency of 10 Hz for
compared to each group.
Abbreviations: AVG: Average; AD: Standard deviation; 15 min/session, administered 5 days/week for 4 weeks.
HAMA: Hamilton Anxiety Scale; HAMD: Hamilton Depression Scale. This protocol demonstrated significant efficacy in reducing

A B C

Figure 2. Changes in primary outcome measures. (A) HAMD score. (B) HAMA score. (C) SS-QOL score.
Abbreviations: HAMA: Hamilton Anxiety Scale; HAMD: Hamilton Depression Scale; SS-QOL: Stroke-Specific Quality of Life Scale.

Volume 9 Issue 2 (2025) 218 doi: 10.36922/EJMO025080032