Clinical Efficacy Study of Escitalopram Combined With Low-Frequency Repetitive Transcranial Magnetic Stimulation in Patients With Post-Ischemic Stroke Depression and Anxiety.
Long Y, Wei Q, et al. • Actas espanolas de psiquiatria • 2026
Escitalopram combined with LF-rTMS can effectively alleviate anxiety and depression in ischemic stroke patients and show beneficial changes in brainstem raphe echogenicity, suggesting it may serve as a potential and promising treatment option for post-ischemic stroke depression and anxiety.
Key Findings
Results
The combined treatment group (escitalopram plus LF-rTMS) achieved a significantly higher total effective rate than the conventional treatment group (escitalopram alone).
80 ischemic stroke patients with concurrent depression and anxiety were retrospectively collected from Jiangbin Hospital of Guangxi Zhuang Autonomous Region, January 2025–December 2025.
40 patients were assigned to each group (conventional treatment vs. combined treatment).
The abstract states the total effective rate in the combined treatment group was 'significantly higher' than in the conventional treatment group, though exact percentages are not provided in the abstract.
Clinical efficacy was evaluated using Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA).
Results
Post-treatment HAMD and HAMA scores were significantly lower in the combined treatment group compared to the conventional treatment group after adjusting for baseline scores.
Scores were collected before and at the end of treatment in both groups.
Baseline score adjustment was applied when comparing post-treatment outcomes between groups.
The combined treatment group received routine treatment plus oral escitalopram plus LF-rTMS.
The conventional treatment group received routine treatment plus oral escitalopram only.
Specific numeric score values and p-values are not reported in the abstract.
Results
The proportion of patients with abnormal brainstem raphe (BR) echogenicity decreased in both groups, with fewer abnormal cases in the combined treatment group than in the conventional treatment group.
Transcranial ultrasound imaging of the brainstem raphe region was performed as an exploratory imaging measure.
Both groups showed a reduction in the proportion of patients with abnormal echogenicity after treatment.
The combined treatment group had fewer patients with abnormal BR echogenicity compared to the conventional treatment group post-treatment.
The authors describe these as 'beneficial changes in BR echogenicity as an exploratory imaging finding,' noting further validation is needed.
Specific proportions or counts are not provided in the abstract.
Results
There was no statistically significant difference in the incidence of adverse reactions between the combined treatment group and the conventional treatment group.
Adverse reactions were recorded during the treatment period for both groups.
The absence of a significant difference suggests that adding LF-rTMS to escitalopram did not meaningfully increase adverse event burden.
Specific types or rates of adverse reactions are not detailed in the abstract.
Methods
The study was retrospective in design, enrolling ischemic stroke patients with concurrent depression and anxiety treated at a single center.
Study period: January 2025 to December 2025.
Setting: Jiangbin Hospital of Guangxi Zhuang Autonomous Region.
Total sample size: 80 patients (40 per group).
Group allocation was retrospective rather than prospective randomization.
The LF-rTMS intervention targeted a low-frequency repetitive transcranial magnetic stimulation protocol, though specific parameters (frequency, sessions, intensity) are not described in the abstract.
What This Means
This research suggests that combining a common antidepressant medication (escitalopram) with a non-invasive brain stimulation technique called low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) may be more effective at treating depression and anxiety in people who have had an ischemic stroke compared to using the medication alone. The study looked at 80 stroke patients in China, splitting them into two groups: one receiving standard care with escitalopram, and the other receiving the same plus LF-rTMS sessions. Patients who received the combined approach showed greater reductions in standardized depression and anxiety scores and had a higher overall treatment response rate.
The study also explored a newer imaging technique — ultrasound of a brain region called the brainstem raphe — which is associated with mood regulation. Both groups showed improvements in this imaging measure, but the combined treatment group showed greater normalization, suggesting that the treatment may be producing real biological changes in the brain, though the authors caution this is an exploratory finding requiring further research.
Importantly, adding LF-rTMS to the medication did not appear to cause additional side effects compared to medication alone, which is an encouraging safety signal. However, because this was a retrospective study at a single hospital with a relatively small sample, the authors themselves note that further validation through larger, prospective, randomized trials is needed before strong conclusions can be drawn. This research suggests that combining brain stimulation with antidepressant medication could be a promising avenue for helping stroke survivors who struggle with depression and anxiety.
Long Y, Wei Q, Deng X, Wei J, Jiang A, Guo Q, et al.. (2026). Clinical Efficacy Study of Escitalopram Combined With Low-Frequency Repetitive Transcranial Magnetic Stimulation in Patients With Post-Ischemic Stroke Depression and Anxiety.. Actas espanolas de psiquiatria. https://doi.org/10.62641/aep.v54i4.2250