Effects of low-frequency rTMS combined with antidepressants on depression in patients with post-stroke depression: a systematic review and meta-analysis

Juanhong Pan; Hongpeng Li; Yongshen Wang; Li Lu; Ying Wang; Tianyu Zhao; Di Zhang; Song Jin

doi:10.3389/fneur.2023.1168333

Effects of low-frequency rTMS combined with antidepressants on depression in patients with post-stroke depression: a systematic review and meta-analysis

Front Neurol. 2023 May 19:14:1168333. doi: 10.3389/fneur.2023.1168333. eCollection 2023.

Authors

Juanhong Pan^#¹, Hongpeng Li^#², Yongshen Wang¹, Li Lu², Ying Wang², Tianyu Zhao³, Di Zhang³, Song Jin³

Affiliations

¹ School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
² School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
³ Rehabilitation Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.

^# Contributed equally.

Abstract

Objective: To evaluate the effect of low-frequency (≤1 Hz) repetitive transcranial magnetic stimulation (low-frequency rTMS) combined with antidepressants on depression and the levels of inflammatory factors IL-6 and TNF-α in patients with post-stroke depression (PSD).

Design: PubMed, Embase, Web of Science, Cochrane Library (CBM), China National Knowledge Infrastructure, Technology Periodical Database, and Wanfang Database were searched until October 2022 for randomized controlled trials.

Participants: Patients with post-stroke depression (PSD) participated in the study.

Results: A total of 16 randomized controlled trials (RCTs) involving 1,463 patients with PSD were included. According to the Physiotherapy Evidence Database (PEDro) quality assessment, three studies received high quality (eight scores) and 13 RCTs received moderate quality (six scores) results. The meta-analysis showed that low-rTMS combined with an antidepressant significantly reduced the Hamilton Depression Scale (HAMD) score and the National Institutes of Health Stroke Scale (NIHSS) score, reduced IL-6 and TNF-α levels, and improved the MMSE score in PSD compared to an antidepressant alone.

Conclusion: The results of this meta-analysis evidenced the efficacy and safety of low-rTMS combined with antidepressants in the treatment of depression in PSD patients. The combined therapy could reduce The depression state and the levels of IL-6 and TNF-α, and enhance the cognitive function of patients. In addition, low-rTMS had fewer adverse effects, proving safety. However, there are shortcomings, such as a lack of long-term follow-up, different intervention sites of low-rTMS, and different intervention frequencies (0.5 or 1 Hz). Thus, in the future, RCTs with a larger sample size and longer-term observation are required to verify the efectiveness of low-rTMS combined therapy on PSD. Meantime, a new meta-analysis could be analysized, which intervention sites and frequency are more effective in treating PSD.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022376845.

Keywords: IL-6 and TNF-α levels; PSD; antidepressants; depressive state; low-rTMS; meta-analysis; systematic review.

Publication types

Systematic Review

Grants and funding

This review was funded by the Sichuan Provincial Administration of Traditional Chinese Medicine (Number: 2022CP0992).