AccScience Publishing / EJMO / Online First / DOI: 10.36922/EJMO025080032
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ORIGINAL RESEARCH ARTICLE

Efficacy of repetitive transcranial magnetic stimulation combined with horticultural therapy for post-stroke depression: A randomized controlled trial

Ying Chen1,2 ,  Sarisak Soontornchai1* ,  Pimporn Thongmuang1* ,  Lu Ye2 ,  Xiaoqiang Qiu3
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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
EJMO, 025080032 https://doi.org/10.36922/EJMO025080032
Received: 17 February 2025 | Revised: 4 April 2025 | Accepted: 8 April 2025 | Published online: 29 April 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Post-stroke depression (PSD) affects approximately one-third of stroke survivors, and current treatments often present limitations. Non-invasive therapies such as repetitive transcranial magnetic stimulation (rTMS) and horticultural therapy (HT) are gaining interest as alternative approaches. This study aimed to evaluate the clinical efficacy of rTMS combined with HT in treating PSD. Eighty PSD patients (aged 30 – 75 years old; 1 month – 2 years post-stroke), diagnosed according to the Chinese Expert Consensus on Clinical Practice of Post-Stroke Depression, were randomly assigned to one of four treatment groups: Group A (antidepressant alone—escitalopram, 10 mg/day), Group B (antidepressant + rTMS), Group C (antidepressant + HT), and Group D (antidepressant + 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 activities (e.g., planting, pruning, watering) conducted 5 days/week. Patients were evaluated using the Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), 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 significant reductions in HAMD and HAMA scores post-treatment compared to baseline (p<0.01). Group D demonstrated a statistically significant improvement in SS-QOL scores (p<0.01), while other groups did not (p>0.01). No significant difference in HAMD scores was found between Groups B and C (p=0.399). These results suggest that combining rTMS and HT provides greater benefits in managing PSD compared to either intervention alone. No serious complications were reported. This study supports the integration of rTMS and HT as an effective adjunct to standard antidepressant therapy for PSD.

Keywords
Horticultural therapy
Repetitive transcranial magnetic stimulation
Depression
Stroke
Stroke rehabilitation
Funding
This study was funded by the Guangxi Medical and Health Appropriate Technology Development, Promotion, and Application Project (grant number: S2022059).
Conflict of interest
The authors declare no conflicts of interest.
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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