Page 228 - EJMO-9-2

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

patients suffering from PSD. Future RCTs are needed to differences between the four treatment groups. Future
optimize the accelerated rTMS protocol and validate these studies would benefit from incorporating more precise and
preliminary findings. As observed in our study, patients validated instruments to better capture the nuanced effects
with PSD often require more intensive or multimodal of different treatment modalities. Finally, the study did
interventions. Food and Drug Administration-approved not present the data for the follow-up period. The 28-day
rTMS offers a viable adjunctive therapy for major treatment duration may have been sufficient to detect
depression. Furthermore, the “Clinical Application and immediate therapeutic effects, but a longer-term follow-up
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Operational Standards of Repetitive Transcranial Magnetic study could provide deeper insights into the durability
Stimulation” outlined in the Shanghai Expert Consensus of the treatment benefits and potentially reveal a greater
(2022) highlights the positive and safe effects of rTMS in degree of improvement over time.
the treatment of stroke-related conditions, including PSD.
These endorsements further promote the utility of rTMS as 5. Conclusion and future perspectives
a future therapy for PSD. This study provides sufficient evidence to support the use
Our study utilized a stimulation frequency and dosing of rTMS combined with HT as a promising treatment
protocol of rTMS that likely promoted the release of option for PSD. The combination therapy demonstrated
neurotransmitters such as serotonin and BDNF in the additional improvements in depressive symptoms beyond
cerebral cortex. These mechanisms are believed to improve those observed with standard therapy alone. These findings
local cerebral blood flow and regulate gene expression highlight the potential of integrating rTMS with HT to
related to neuronal excitability, thereby alleviating enhance recovery in patients with PSD. However, further
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depressive symptoms. These findings align with those research with larger sample sizes, more sensitive assessment
of Shen et al., who conducted a systematic review and tools, and extended follow-up periods is needed to validate
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meta-analysis on RCTs and concluded that rTMS is both these results and optimize treatment protocols. Therefore,
effective and safe for the treatment of PSD. future studies should focus on optimizing synergistic
strategies for non-drug treatment, including identifying
Previous studies, such as Berlim et al., have explored the optimal combination of rTMS parameters (e.g.,
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similar high-frequency protocols for depression, with frequency, stimulation site) and HT types. Further clinical
session duration ranging from 15 to 20 min and treatment validation is required. Our study is expected to contribute
periods extending up to 6 weeks. These studies consistently to the development of a safer and more comprehensive
demonstrated significant improvements in depressive rehabilitation program by minimizing side effects while
symptoms, supporting the efficacy of high-frequency maximizing the treatment efficacy.
rTMS. In addition, Li et al. reported that the effects of
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rTMS intervention were mainly plays a short-term role Acknowledgments
statistically significant. We have observed statistically
significant results over a 28-day clinical trial period. Next, The authors would like to thank Dr. Xiaojing Guo for her
we will consider extending the treatment period up to helpful suggestions related to the research methodology
6 weeks to investigate whether rTMS, when combined and statistical analysis.
with other interventions such as HT, would sustain its Funding
therapeutic potential and long-term benefits.
This study was funded by the Guangxi Medical and Health
Several limitations were identified in this study. First,
the small sample size and single-center design limit the Appropriate Technology Development, Promotion, and
Application Project (grant number: S2022059).
generalizability and statistical power to demonstrate
the superiority of rTMS combined with HT over other Conflict of interest
treatment groups. Larger, multicenter studies are needed
to better evaluate the comparative effectiveness of this The authors declare no conflicts of interest.
combination therapy. Second, participants in this study Author contributions
exhibited heterogeneous clinical features, including
variations in the time from stroke onset, the type of Conceptualization: Ying Chen, Sarisak Soontornchai
depression, and the severity of depressive symptoms. Formal analysis: Lu Ye
While this heterogeneity reflects real-world clinical Investigation: Ying Chen, Sarisak Soontornchai
practice, it also limits the universality of the results to Methodology: Xiaoqiang Qiu, Pimporn Thongmuang
broader populations. Third, the assessment tools used in Writing – original draft: Ying Chen, Lu Ye
this study may not be sensitive enough to detect subtle Writing – review & editing: Ying Chen, Lu Ye

Volume 9 Issue 2 (2025) 220 doi: 10.36922/EJMO025080032