Page 227 - EJMO-9-2

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

depressive and anxiety symptoms, particularly when our study aimed to explore whether the combined
combined with HT. Regarding the primary objectives of our therapy could shorten the overall treatment duration.
study, we found that following the intensive daily treatment, However, due to a high dropout rate during follow-up,
immediate results indicated a significant improvement in we currently lack sufficient data to confirm this effect.
depressive symptoms among PSD patients treated with Nonetheless, preliminary observations indicate that most
rTMS combined with HT. Previous studies have shown patients continued to show improvement, which will be an
that mindfulness-based stress reduction combined with important focus of our future research.
low intensity transcranial electrical stimulation effectively While previous studies have primarily focused on the
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enhances psychological comfort and well-being. use of rTMS as a standalone treatment for depression or
Although these studies primarily focused on patients PSD, our findings highlight the added value of combining
with generalized anxiety disorder, and the heterogeneity rTMS with HT. This combination appears to address not
of mindfulness-based interventions introduces some only the neural dysfunction underlying PSD but also
limitations to drawing definitive conclusions, this growing the psychological and behavioral aspects of recovery,
body of research supports the benefits of combining rTMS contributing to a more holistic improvement in patients’
with non-pharmacological therapies to improve quality health-related quality of life. Moreover, the sustained effects
of life. 34-37 Taylor et al. have suggested that rTMS can observed in our study, in contrast to Li et al.’s findings
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alleviate depressive symptoms safely. Building on this, our of diminishing rTMS effects, suggest that the combined
future research will further explore the neural mechanisms treatment with HT may play a critical role in maintaining
underlying rTMS in combination with mindfulness-based the therapeutic gains achieved with rTMS.
stress reduction. Our current findings suggest that HT may
help sustain the effects of rTMS, offering a more potentially Although our rTMS dosing protocol aligns with
durable treatment approach for PSD patients. established guidelines, the integration of HT represents
a novel therapeutic approach that warrants further
In our study, patients in Group B received rTMS at
a frequency of 10 Hz for 15 min/session, administered exploration. Future studies should investigate the neural
mechanisms underlying this combination therapy and
5 days/week for 4 weeks. This protocol aligns with the assess whether variations in rTMS dosing parameters could
standard high-frequency rTMS protocols commonly further optimize treatment outcomes in PSD patients. rTMS
used in the treatment of depression. Previous studies remains one of the most precise methods for controlling
have demonstrated that high-frequency stimulation of the
dorsolateral prefrontal cortex is effective in modulating the frequency and location of brain stimulation, offering
distinct advantages over other therapeutic approaches.
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neural circuits associated with mood regulation and Our data supports the hypothesis that rTMS is a safe
improving depressive symptoms. For instance, O’Reardon and viable option to treat PSD symptoms. In addition to
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et al. used a similar protocol of 10 Hz stimulation for rTMS, HT has also been shown to improve depression in
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4 – 6 weeks in patients with major depressive disorder patients with PSD. However, the results of studies on HT
and reported significant clinical improvements. Similarly, vary significantly due to numerous factors, including the
Berlim et al. conducted a meta-analysis of rTMS studies
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and found that high-frequency stimulation protocols time elapsed from the onset of the stroke to the initiation
ranging from 10 Hz to 20 Hz were associated with robust of treatment, the severity of depression, the dose, and
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antidepressant effects. Moreover, variations in rTMS dosing the specific protocol of HT employed. These variables
parameters, such as session duration, frequency, and total can substantially influence the effectiveness of HT in the
treatment of depression. The severity of depression is a
number of sessions, can influence treatment outcomes. particularly strong predictor of response to therapy. In
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For example, Fitzgerald et al. demonstrated that longer our study, the severity of depression was assessed using
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session duration and higher total pulses per session (e.g.,
20 min of stimulation) may lead to more pronounced the HAMD score. The mean baseline HAMD score of the
symptom improvements in treatment-resistant depression. intervention groups was 24.5, which is classified as severe
Compared to these studies, our protocol utilized a relatively depression. This high baseline severity likely influenced
moderate session duration (15 min) and treatment period the outcomes observed in our study. Notably, our results
(4 weeks), which may explain the relatively rapid onset of did not show the superiority of HT over rTMS in terms of
symptom relief observed. Furthermore, Li et al. noted effectiveness.
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that rTMS mainly plays a short-term role in post-stroke On the other hand, a study reported that high-
aphasics. Longer-term and large-scale studies are essential frequency rTMS treatment over 2 weeks was effective in
to explore the effect of rTMS with different frequencies treatment-resistant major depressive disorder and may
on post-stroke aphasia. By integrating HT with rTMS, serve as an effective alternative or adjunctive therapy for

Volume 9 Issue 2 (2025) 219 doi: 10.36922/EJMO025080032