Psychological and neurobiological outcomes of combined rTMS and robotic therapy in post-stroke depression: A randomized controlled study

This randomized controlled study evaluated the psychological, functional, and neurobiological effects of repetitive transcranial magnetic stimulation (rTMS) combined with intelligent robot-assisted rehabilitation in patients with post-stroke depression (PSD). Ninety eligible inpatients with PSD were randomized equally to an experimental group receiving 10-Hz rTMS plus robot-assisted rehabilitation and conventional rehabilitation, or to a control group receiving escitalopram plus conventional rehabilitation, for four weeks. Outcomes included depressive symptoms, functional independence, gait function, anxiety, social functioning, quality of life, and peripheral biomarkers including BDNF, cortisol, IL-6, and TNF-alpha. The experimental group showed greater improvement in HAMD and MBI scores after adjustment for baseline values, improved gait outcomes, and favorable within-group changes in anxiety, social-function, and quality-of-life measures. Biomarker analyses showed increased BDNF expression and decreased cortisol, IL-6, and TNF-alpha levels after treatment. These findings suggest that combined rTMS and intelligent robot-assisted rehabilitation is a feasible non-pharmacological intervention for PSD and may improve both psychological and functional outcomes, potentially through enhanced neuroplasticity and reduced inflammatory activity. Larger multicenter randomized trials with sham-control arms and longer follow-up are needed to confirm efficacy, durability, and mechanisms.