1. Introduction
deaths, death, Stroke, stroke, Post-stroke depression, depressed symptoms, depression, Depression, disability
ADVERSE REACTIONS, STROKE, STROKE
Background: Post-stroke depression (PSD) is most prevalent during the rehabilitative period following a stroke. Recent studies verified the effects of repetitive transcranial magnetic stimulation therapy (rTMS) and mindfulness-based stress reduction (MBSR) in patients with depression. However, the effectiveness and prospect of application in PSD patients remain unclear. This study sought to evaluate the effectiveness of a combined intervention based on rTMS and MBSR for the physical and mental state of PSD patients. Methods: A randomized, double-blind, sham-controlled study design was employed. Participants were recruited from the Rehabilitation Medicine Centre and randomly assigned to receive either MBSR combined with active or sham rTMS or sham rTMS combined with general psychological care. We used a 17-item Hamilton Depression Rating Scale (HAMD-17), a mini-mental state examination (MMSE), the Modified Barthel Index (MBI), and the Pittsburgh Sleep Quality Index (PSQI) to evaluate depressed symptoms, cognitive function, activities of daily living (ADL), and sleep quality at baseline, post-intervention, and the 8-week follow-up. A two-factor analysis of variance was used to compare differences between groups, and Pearson’s linear correlation was used to analyze the possible relationship between variables and potential predictors of depression improvement. Results: Seventy-two participants were randomized to rTMS–MBSR (Stroke was the third highest cause of death and disability (5.7% [5.2–6.2] of total disability-adjusted life years (DALYs)) and the second highest cause of death globally (11.6% [10.8–12.2] of total deaths) in 2019 [Anti-depressants are still mainstream treatments for PSD. However, many patients do not improve with such therapy because of the long treatment cycle and adverse reactions [Together with rTMS, one innovative strategy includes mindfulness-based interventions (MBIs) such as mindfulness-based stress reduction (MBSR). Mindfulness is an inner state of consciousness with an operational definition that includes “self-regulation of attention” and “orientation to experience” [Based on this evidence, our study team hypothesized that rTMS combined with MBSR could result in greater synergistic effects than independently using either therapy. To our knowledge, no clinical trial investigating the efficacy of rTMS–MBSR for PSD patients has been published. Our study used a Modified MBSR Curriculum introduced by Gray (a stroke survivor and certified MBSR instructor) to guide clinical operation [