Depressive symptom dimensions predict the treatment effect of repetitive transcranial magnetic stimulation for post-stroke depression
Abstract
Objective Repetitive transcranial magnetic stimulation (rTMS) has attracted considerable attention because of its non-invasiveness, minimal side effects, and treatment efficacy. Despite an adequate duration of rTMS treatment, some patients with post-stroke depression (PSD) do not achieve full symptom response or remission.Methods This was a prospective randomized controlled trial. Participants receiving rTMS were randomly assigned to the ventromedial prefrontal cortex (VMPFC), left dorsolateral prefrontal cortex (DLPFC), or contralateral motor area (M1) groups in a ratio of 1:1:1. Enrollment assessments and data collection were performed in weeks 0, 2, 4, and 8. The impact of depressive symptom dimensions on treatment outcomes were tested using a linear mixed-effects model fitted with maximum likelihood. Univariate analysis of variance (ANOVA) and back-testing were used to analyze the differences between the groups.Results In total, 276 patients were included in the analysis. Comparisons across groups showed that 17-item Hamilton Rating Scale for Depression (HAMD-17) scores of the DLPFC group significantly differed from those of the VMPFC and M1 groups at 2, 4, and 8 weeks after treatment (p < 0.05). A higher observed mood score (β = -0.44, 95% confidence interval [CI]: -0.85-0.04, p = 0.030) could predict a greater improvement in depressive symptoms in the DLPFC group. Higher neurovegetative scores (β = 0.60, 95% CI: 0.25-0.96, p = 0.001) could predict less improvement of depressive symptoms in the DLPFC group.Conclusion Stimulation of the left DLPFC by high-frequency rTMS (HF-rTMS) could significantly improve depressive symptoms in the subacute period of subcortical ischemic stroke, and the dimension of depressive symptoms at admission might predict the treatment effect.
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The sample size was calculated to detect a difference in HAMD scores between groups based on Xiuli et al.'s study, yielding approximately 25 per group, inflated by 30% to 33 per group (66 total).
“According to the above formula, the sample size of each group was about 25 cases. Taking into account the sample loss and other problems, each group was expanded by 30%. Therefore, the final sample size for each group was approximately 33 cases, a total of 66 cases were required.”
From Effect of group-based acceptance and commitment therapy on older stroke survivors: study protocol for a randomized controlled trial. (2023) · cites this paper as [27]
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- Authors
- Qiu, X., Lan, Y., Miao, J., Pan, C., Sun, W., Li, G., Wang, Y., Zhao, X., Zhu, Z., & Zhu, S.
- Affiliations
- Tongji Hospital (CN)
- Corresponding author
- Zhu, Zhou
- Zhu, Suiqiang
- ORCID
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2023-08
- Volume
- 171
- Pages
- 111382
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W4377030612
- Cited by
- 14
- References
- 48
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 6 · 2023: 2
- FWCI
- 1.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Hubei Technological Innovation Special Fund (2019ACA132)
- National Key Research and Development Program of China (2017YFC1310000)
- National Natural Science Foundation of China (82101605, 82171465, 82001218)
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- repetitive transcranial magnetic stimulation, post-stroke depression, treatment response prediction, dorsolateral prefrontal cortex, ventromedial prefrontal cortex, motor cortex stimulation, neurovegetative symptoms, mood, subcortical ischemic stroke, subacute stroke, high-frequency rTMS
- MeSH terms
- Depression, Humans, Prospective Studies, Treatment Outcome, Prefrontal Cortex, Transcranial Magnetic Stimulation
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