Clinical Efficacy Study of Escitalopram Combined With Low-Frequency Repetitive Transcranial Magnetic Stimulation in Patients With Post-Ischemic Stroke Depression and Anxiety

Abstract

Background: To retrospectively analyze the clinical efficacy of escitalopram combined with low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) in treating anxiety and depression in ischemic stroke patients.

Methods: Eighty ischemic stroke patients with concurrent depression and anxiety who received treatment at Jiangbin Hospital of Guangxi Zhuang Autonomous Region from January 2025–December 2025 were retrospectively collected. Patients were divided into a conventional treatment group and a combined treatment group, with 40 patients in each group. The conventional treatment group received routine treatment combined with oral escitalopram, while the combined treatment group received the same treatment as the conventional treatment group, combined with LF-rTMS. To evaluate clinical efficacy, Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA) scores were collected before and at the end of treatment in both groups. Transcranial ultrasound imaging of the brainstem raphe (BR) region was also performed, and adverse reactions during treatment were recorded.

Results: The total effective rate in the combined treatment group was significantly higher than that in the conventional treatment group. After adjusting for baseline scores, post-treatment HAMD and HAMA scores in the combined treatment group were significantly lower than those in the conventional treatment group. The proportion of patients with abnormal echogenicity decreased in both groups, and the number of patients with abnormal echogenicity in the combined treatment group was less than that in the conventional treatment group. There was no statistically significant difference in the incidence of adverse reactions between the two groups.

Conclusions: Escitalopram combined with LF-rTMS can effectively alleviate anxiety and depression in ischemic stroke patients and show beneficial changes in BR echogenicity as an exploratory imaging finding. It may serve as a potential and promising treatment option for post-ischemic stroke depression and anxiety, although further validation is needed.