Repetitive transcranial magnetic stimulation as treatment of poststroke depression: a preliminary study

Biol Psychiatry. 2004 Feb 15;55(4):398-405. doi: 10.1016/j.biopsych.2003.08.017.


Background: Depression has a significant impact on poststroke recovery and mortality. There are a proportion of patients with poststroke depression (PSD) who do not respond to antidepressants. Repetitive Transcranial Magnetic Stimulation (rTMS) might be a safe and effective alternative in these refractory cases.

Methods: We conducted a randomized, parallel, double-blind study of active versus sham left prefrontal rTMS in patients with refractory PSD. After discontinuing antidepressants, patients were randomly assigned to receive 10 sessions of active (10 Hz, 110% of the motor threshold, 20 trains of 5 seconds duration) or sham left prefrontal rTMS. Efficacy measures included HAM-D scores, response and remission rates. Patients completed a neuropsychological battery at baseline and after completing the protocol.

Results: When compared with sham stimulation, 10 sessions of active rTMS of the left dorsolateral prefrontal cortex were associated with a significant reduction of depressive symptoms. This reduction was not influenced by patient's age, type or location of stroke, volume of left frontal leukoaraiosis or by the distance of the stimulating coil to the prefrontal cortex. However, there was a significant positive correlation between the percentage of reduction of Ham-D scores and frontal gray and white matter volumes. There were no significant changes in cognitive functioning between the active and the sham stimulation groups. In addition, there were few and mild adverse effects that were equally distributed among groups.

Conclusions: Taken together, these preliminary findings suggest that rTMS may be an effective and safe treatment alternative for patients with refractory depression and stroke.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antidepressive Agents / therapeutic use
  • Brain Infarction / pathology
  • Brain Mapping
  • Cognition
  • Depression / etiology
  • Depression / pathology
  • Depression / therapy*
  • Diagnostic and Statistical Manual of Mental Disorders
  • Double-Blind Method
  • Electric Stimulation Therapy / methods*
  • Female
  • Humans
  • Infarction, Middle Cerebral Artery / pathology
  • Intelligence Tests
  • Language
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Psychiatric Status Rating Scales
  • Psychomotor Performance
  • Severity of Illness Index
  • Stroke / complications*
  • Stroke / pathology
  • Stroke / therapy
  • Transcranial Magnetic Stimulation*
  • Treatment Outcome
  • Verbal Learning


  • Antidepressive Agents