LF-rTMS on the right DLPFC combined with conventional treatment may be a safe approach to alleviate depressive symptoms in patients with PSD, with fNIRS revealing the mechanism may be related to improving left-right brain tissue blood flow and activation balance.
Key Findings
Results
HAMD scores in the rTMS group decreased significantly more than those in the control group after treatment.
28 patients were randomly assigned to the rTMS group (n = 14) and control group (n = 14)
The Hamilton Depression Scale (HAMD) was used to assess treatment effect
The difference in HAMD score reduction between groups was statistically significant (p < 0.05)
The treatment targeted the right dorsolateral prefrontal cortex (DLPFC) with low-frequency rTMS combined with conventional treatment
Results
The rTMS group showed significantly greater improvements in anxiety, stroke severity, and functional independence compared to the control group.
Hamilton Anxiety Scale (HAMA) scores improved significantly more in the rTMS group (p < 0.05)
National Institutes of Health Stroke Scale (NIHSS) scores improved significantly more in the rTMS group (p < 0.05)
Barthel Index (BI) scores improved significantly more in the rTMS group (p < 0.05)
These improvements suggest LF-rTMS has broad benefits beyond depression alone in PSD patients
Results
fNIRS detected significant changes in oxyhemoglobin and deoxyhemoglobin concentrations in the frontal cortex following rTMS treatment.
Oxyhemoglobin (HbO) in channel 17 (CH17) increased after rTMS (p < 0.05)
Deoxyhemoglobin (HbR) in channel 6 (CH6) decreased after rTMS (p < 0.05)
When comparing rTMS group to control group, HbR in CH6 and CH8 decreased significantly while HbR in CH12 and CH15 increased significantly (p < 0.05)
fNIRS was used to detect changes in blood oxygen concentration specifically in the frontal cortex
Discussion
The neural mechanism of LF-rTMS in PSD may be related to improving left-right brain tissue blood flow and activation balance.
fNIRS revealed differential hemodynamic changes across left and right frontal cortex channels
The pattern of HbO and HbR changes across multiple channels suggests modulation of interhemispheric activation balance
The authors interpreted the fNIRS findings as evidence for improved left-right brain tissue blood flow balance as the mechanism of action
This is described as a pilot study, indicating preliminary exploratory findings
Conclusions
LF-rTMS applied to the right DLPFC combined with conventional treatment was found to be safe in patients with post-stroke depression.
Safety was evaluated as part of the study outcomes
The study included 28 post-stroke depression patients in a randomized design
No safety concerns were reported that would preclude the approach
The authors concluded this represents 'a safe approach to alleviate depressive symptoms in patients with PSD'
What This Means
This research suggests that applying low-frequency magnetic stimulation (called repetitive transcranial magnetic stimulation, or rTMS) to the right side of the brain's prefrontal region can meaningfully help people who develop depression after having a stroke. In this small pilot study of 28 patients, those who received rTMS in addition to standard care showed greater reductions in depression and anxiety symptoms, better stroke recovery scores, and improved ability to perform daily activities compared to those who received standard care alone. The treatment was also found to be safe.
The study also used a brain imaging technology called functional near-infrared spectroscopy (fNIRS) to look at what was happening in the brain during treatment. This technology measures blood oxygen levels in the frontal part of the brain as a proxy for brain activity. The results showed that rTMS caused changes in blood oxygen patterns on both sides of the frontal cortex, suggesting the treatment may work by helping to rebalance brain activity between the left and right hemispheres — an imbalance that may contribute to post-stroke depression.
This research matters because post-stroke depression is a common and serious complication that can interfere with recovery, but treatment options are not always effective or well-tolerated. This small pilot study suggests rTMS targeting the right prefrontal cortex is a promising and safe option worth investigating further in larger trials. The use of fNIRS also provides early clues about the biological mechanism through which rTMS might produce its antidepressant effects in stroke patients.
Fan Y, Zhong Y, Yu A, Jiang X, Zhao H, Wang Y, et al.. (2026). Efficacy and safety of low-frequency repetitive transcranial magnetic stimulation in post-stroke depression: A fNIRS pilot study.. Psychiatry research. https://doi.org/10.1016/j.psychres.2026.117244