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

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 &ndash; 75 years old; 1 month &ndash; 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&mdash;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.